Peace Corps MTG FOIA Volunteer Health Support

Peace Corps
Technical Guideline 300

IMMUNIZATION
1.
PURPOSE
To provide recommendations regarding the use and administration of vaccines.

2.
BACKGROUND
Recommendations for vaccination are based on characteristics of immunobiologics, scientific

knowledge about the principles of active and passive immunization, the epidemiology of
diseases, and judgments by public health officials and specialists in clinical and preventive
medicine.
All immunobiologics have benefits and risks; no vaccine is completely safe or completely
effective.
Benefits of vaccination range from partial to complete protection against the

consequences of infection.
Risks of vaccination range from common, minor and inconvenient side effects to rare,
severe, and life-threatening conditions.
Recommendations for immunization balance the scientific evidence of benefits, costs, and
risks. The Peace Corps Medical Officer (PCMO) must be fully acquainted with all vaccines
administered and should consult the following publications for additional information:
Office of Health Services
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Health Information for International Travel (The Yellow Book)

A book prepared by the Centers for Disease Control and Prevention (CDC) that is published every
two years as a reference for those who advise international travelers about health risks. Available
online at: http://wwwnc.cdc.gov/travel/page/yellowbook-home-2014 (go to Table of Contents)
General Recommendations on Immunization: Recommendations of the Advisory Committee on
Immunization Practices (ACIP)
Covers administration and spacing of vaccines, hypersensitivity reactions, special situations, and
misconceptions concerning true contraindications and precautions to vaccination. Available at:
http://www.cdc.gov/vaccines/hcp/acip-recs/
Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book)
Typical chapters include a description of the disease, pathogenesis, clinical features, laboratory
diagnosis, medical management, epidemiology, risk factors, vaccine details, vaccination schedule and
use, contraindications and precautions to vaccination, adverse reactions following vaccination,
vaccine storage and handling, and reference or publications. Available at:
http://www.cdc.gov/vaccines/pubs/pinkbook/index.html
VISs for all vaccines administered in the Volunteer health system can be found at
http://www.cdc.gov/vaccines/hcp/vis/current-vis.html.
Detailed information on immunization and specific vaccines is also published in the Red Book
published by the American Academy of Pediatrics and periodically in Morbidity and Mortality
Weekly Report (MMWR).
3. RECOMMENDED VACCINATIONS
See ATTACHMENT A for recommended vaccines.
4. VACCINE ADMINISTRATION
4.1
Types of Vaccines
There are three main types of immunizations available. Live vaccines and inactivated
vaccines both provide immunity by stimulating the immune system whereas passive
vaccines contain antibodies and provide immediate immunity without stimulating an
immune response.
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Live Vaccines
BCG*
Influenza
Measles, Mumps/Rubella
(MMR)
Oral Polio (OPV) **
Oral Typhoid (Ty21a)
Rotavirus*
Varicella**
Yellow Fever
Inactivated Vaccines
Anthrax*
Cholera*
Diphtheria
Tetanus
Pertussis*
Hemophilus Influenzae
type B**
Hepatitis A
Hepatitis B (recombinant)
Hepatitis A & B
HPV2, HPV4*
Human Papilloma Virus*
Influenza
Japanese Encephalitis***
Lyme Disease*
Meningococcal
Plague*
Pneumococcal
Inactivated Polio Virus
(IPV)
Rabies
Tick-borne encephalitis
(TBE)
Typhoid (ViCPS or
inactivated)
Zoster
Passive Vaccines
Immune Globulin (IG)**
Human Rabies Immune
Globulin (HRIG)
Hepatitis B Immune
Globulin (HBIG)**
Varicella Zoster Immune
Globulin (VZIG)**
*
indicates vaccines which are not indicated for use by Volunteers at this time
** indicates vaccines with very limited use
*** indicates vaccine approved for PC use, not licensed in the US
4.2
Vaccine-Induced Anaphylaxis
4.3
The PCMO should be familiar with the signs, symptoms and management of
anaphylaxis (see TG 615).
Anaphylaxis may occur with any vaccination, even if that vaccine has been given
before.
Wherever vaccinations are given, equipment and medication for emergency
treatment of anaphylaxis must be available for immediate use. The anaphylaxis
treatment protocol must be posted in any area where vaccines are administered.
Principles of Vaccine Administration

A summary of the most important principles regarding administration of vaccines is
included in this guideline. PCMOs should refer to reference materials provided above
for more detailed information on the general principles of vaccine administration:
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Primary Immunization
Many vaccines require more than one dose to provide adequate immunity.
Interval between Doses (primary immunization series)
Doses of vaccines should be given as specified in this guideline to produce

adequate immunity as soon as possible. Slightly increasing dose intervals to
conform to Pre-Service training and conference schedules is permitted. Decreasing
intervals during primary immunization for any reason is not acceptable (see below).
Increased Time between Doses: Increasing the time between doses does not reduce
the final antibody concentration. If a dose is delayed, it is not necessary to repeat
the entire series or to add extra doses. However, if any dose in a primary series is
delayed, subsequent doses should be rescheduled according to the recommended
interval schedule in the primary series (see example below). PCMOs should make
every effort to administer doses on time and according to the recommended interval
schedule to provide protection at the earliest date.
EXAMPLE: Rabies vaccine is recommended on days 0, 7, and 21 (see
section 10). If the second dose is delayed until day 10, the third dose
would be given no sooner than day 24. The second dose must be given at
least seven days after the first and the third dose must be given at least 14
days after the second. Note that the 21 day schedule has been chosen to
provide pre-exposure immunity as quickly as possible.
Decreased time between doses: Decreasing the time between doses may decrease
the antibody response. If a dose is given before it is due, PCMOs should not count it
as part of the immunization series and should continue the series as if it had not
been given, i.e., repeat the dose at the appropriate time.
Booster Doses
Booster doses are doses given after a completed primary immunization series, e.g.,
tetanus boosters every ten years for Volunteers. Some vaccines do not require
booster doses. For those that do, the booster will be effective if given anytime
within the recommended booster interval (within ten years for tetanus vaccine in the
preceding example). Exceeding the recommended interval could result in a decrease
in protection.
RECAP NOTE:
Vaccine doses for primary immunization must be given no sooner than the
recommended interval.
Booster doses should be given no later than the recommended interval.
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Simultaneous Administration of Vaccines

All vaccines described in this guideline may be administered simultaneously or at any
interval before or after each other except:
MMR and YELLOW FEVER
Must be given simultaneously (at two

different injection sites) or,
Given at least four weeks apart.
In summary, the recommendations regarding the administration of multiple vaccines

are as follows:
Inactivated vaccines
All inactivated vaccines may be given any time before, with, or after other
inactivated vaccines, live vaccines, or immune globulin. Injections should be given
at separate sites.
Live vaccines and inactivated vaccines

Live vaccines may be given any time before, with, or after inactivated vaccines
Multiple live vaccines at the same time

All live vaccines may be given at the same time, at separate injection sites.
Multiple live vaccines given at different times

Of the live vaccines currently in use by Peace Corps (MMR, yellow fever, oral
typhoid), only MMR and yellow fever vaccines are known to interfere with each
other. If not given simultaneously, MMR and yellow fever vaccines must be given
at least four weeks apart.
Adverse Reactions (Side-effects)

In general, live vaccines produce more adverse reactions than inactivated vaccines.
Common symptoms include: low grade fever, headache, and myalgia. Acetaminophen
can be used to treat these adverse reactions.
Refer to ATTACHMENT B, a summary of indications and administration of
vaccinations, and to the technical information provided on each vaccine in section 10.
4.4
Hypersensitivity to Vaccine Components

Vaccine components cause allergic reactions in some recipients. These reactions can be
local or systemic, and can include life-threatening anaphylaxis. The components of the
vaccine responsible for these hypersensitivity reactions can be the vaccine antigen,
animal or egg protein, antibiotics, preservatives or stabilizers used in the vaccine.
Some of the more common causes of vaccine hypersensitivity reactions are:
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Egg proteins
Egg proteins are found in MMR, influenza, yellow fever, and purified chick embryo
cell rabies vaccines. Persons who can eat eggs or egg-containing foods without
adverse effects can safely receive these vaccines. Persons with urticaria,
angioedema, throat swelling, or other reactions (even if mild) are at risk for severe
allergic reactions. PCMOs should consult OMS when considering vaccination of
persons who may be allergic to egg proteins.
4.5
Neomycin
Only if the Volunteer has had an anaphylactic reaction to neomycin in the past, s/he
should not receive the rabies vaccine, MMR, Varicella, or polio vaccine.
Vaccinations for Volunteers Traveling During and After Service

When logistically possible, PC should provide the primary series of vaccines, if those are
recommended by this guideline (see p.8 Technical Reference Information on individual
vaccines), to Volunteers who will be traveling outside their country during service. The
exception is pre-exposure rabies vaccination, which should not be given for short term
travel. Volunteers should be instructed on steps to take if a bite occurs in a rabies endemic
area (alter plans, go to travel clinic for treatment).
Booster doses of approved vaccines may be given to Volunteers at COS who do not plan to
return to the U.S. within 30 days of COS and who medically require the vaccine for travel
in a destination.
A primary series of an approved vaccine may be initiated for Volunteers at COS who do
not plan to return to the U.S. within 30 days of COS and medically require the vaccine for
travel in a destination country.
PCMOs should account for this when ordering vaccines, using historical data for
prediction. The vaccine should be available in the Health Unit or provided (reimbursed)
through another reliable local source, e.g., Department of State or Ministry of Health clinic
if those are available.
Yellow fever vaccine can only be given at official yellow fever vaccination clinics or
centers. If the clinic is not available, the responsibility lies with the Volunteer.
Note: Persons who have already COSed are not eligible to receive vaccines from
the PC Health Unit.
4.6
Vaccinating Febrile Patients
Minor illnesses such as mild upper respiratory infections are not a reason to delay.
Although a moderate or severe acute illness is sufficient reason to postpone
vaccination, minor illnesses (such as diarrhea, mild upper respiratory infection
with or without low-grade fever, other low-grade febrile illness) are not
contraindications to vaccination (CDC, 2016).
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4.7
People with moderate or severe acute illness, with or without fever, should be
vaccinated as soon as the condition improves. This precaution is to avoid
superimposing adverse effects from the vaccine on underlying illness, or mistakenly
attributing a manifestation of underlying illness to the vaccine.
Live vaccines and pregnancy

Live vaccines are generally not given to pregnant women (or women who may become
pregnant within three months of vaccination) as there is a theoretical risk to the
developing fetus.
4.8
Vaccine Information and Consent

Peace Corps requires that PCMOs provide vaccine information to Trainees/Volunteers
and that Volunteers give informed consent before being vaccinated.
The Vaccine Consent Form (ATTACHMENT C) (PC-1634)
The Vaccine Consent Form is found in this TG. The PCMO must complete section 3 of
this form for each Volunteer. The Volunteers must review the Vaccine Information
Sheet (VIS) (See section 4.9) for each vaccine and complete section 4 of the Vaccine
Consent form, prior to vaccination. Once the Vaccine Consent Form is completed, it
must be scanned and uploaded into the Volunteer Waivers/consents document folder in
PCMEDICS.
Vaccine Information Sheets (VIS)
The National Childhood Vaccine Injury Act requires that federally developed Vaccine
Information Statements (VISs) be provided to vaccine recipients before vaccination.
VISs for all vaccines administered in the Volunteer health system can be found at
http://www.cdc.gov/vaccines/hcp/vis/current-vis.html. The PCMO must provide the
VISs to all Volunteers prior to immunization of any vaccine.
PCMOs have shared VIS statements with PCVs/PCTs in a variety of ways:
Circulate laminated cards for Trainees/ Volunteers to read and return
Provide them with the VIS mobile link:
http://www.cdc.gov/vaccines/hcp/vis/current-vis.html
Distribute VISs on flash/ thumb drive
Provide to each Trainee a paper packet containing all VISs for PST
immunizations
Provide an individual VIS printout for a one-on-one immunization
4.9
Recording immunizations
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The following information should be recorded in the Volunteers PCMEDICS

Immunizations section via the Volunteer Summary page or the Mass Immunizations
feature:
Name and title of the person administering the vaccine;
Type of Vaccine
Dosage
Expiration date;
Date the vaccine was administered;
Vaccine manufacturer;
Vaccine lot number;
VIS Date;
Education Date.
View of immunization information in PCMEDICS:
PCMEDICS Immunization Roster

The purpose of the Immunization Roster in PCMEDICS is to efficiently capture and
display the current immunization status of Trainees and Volunteers. Information that
populates this page comes from the individual Volunteer records. It can be viewed in
PCMEDICS or exported to Excel. See PCMEDICS User Script 20 Immunization
Roster.
Individual Immunization Entry Into PCMEDICS
The Health Unit should update individual records via the Volunteer Summary page (see
PCMEDICS User Script 17 Logging Immunizations)
Mass Immunizations for Groups of Volunteers
The Mass Immunizations feature streamlines the process of documenting
immunizations administered to a group of Volunteers into their individual medical
record. Information documented in this feature populates the individuals medical
record as well as the Immunization Roster. See PCMEDICS User Script 21 Mass
Immunizations.
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For detailed instructions on how to use these PCMEDICS immunization features, refer
to the PCMEDICS user scripts that can be found at:
https://in.peacecorps.gov/HQ/OHS/HIU/_layouts/15/start.aspx#/User%20Scripts
Paper Immunization Rosters/Records
Paper Immunization Roster and Immunization Records are no longer necessary as this
information is placed directly on PCMEDICS.
WHO Cards
Peace Corps no longer provides WHO cards. If a Volunteer presents a WHO Card to
the health unit requesting in-service vaccines be documented on it, the PCMO may
document the immunizations administered during service.
4.10 Special circumstances
Splenectomy: If an Applicant has had a splenectomy, the applicant must have received
the meningococcal, Haemeophilus Influenzae type b, and Pneumococcal vaccines prior to
entry on duty.
4.11 US Department of State Vaccination list
Whenever possible, FDA-licensed vaccines are to be used at Peace Corps Medical Units
overseas. When an FDA-licensed vaccine is either unavailable through normal
procurement channels or unreasonably delayed in shipment, a more readily obtained
equivalent non-FDA licensed vaccine manufactured by well-known reputable multinational pharmaceutical companies may be considered.
ATTACHMENT D is a list of State MED-approved vaccines. The US Department of
State maintains a list of approved vaccines which are for use overseas but not available in
the US. These are acceptable for Peace Corps Medical Officers to stock and administer.
Also listed are vaccines that are not approved by State MED and Peace Corps.
4.12 Immunizations Necessary for PCMOs/ PCMOs on TDY
All PCMOs may be reimbursed for the annual influenza vaccine. See ATTACHMENT
E.
Host Country National (HCN) PCMOs who are traveling on temporary duty status (TDY)
and require immunizations for the TDY country of service will be reimburseed from
OHS for vaccination-incurred costs. Traveling (TDY) PCMOs should save vaccine
related receipts and submit them with the travel voucher after travel. If possible, vaccine
related costs should be added to the TA prior to travel.
5. REPORTING ADVERSE REACTIONS (VAERS)
The Vaccine Adverse Event Reporting System (VAERS) is a system designed for the
collection and analysis of reports of adverse events following use of any vaccine in the U.S.
In the U.S., all providers are required to report all vaccine adverse events using this system.
The VAERS is a passive reporting system.
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Peace Corps works with the CDC to participate in the VAERS system. The VAERS accepts
all vaccine reports, including reports for non-U.S. licensed vaccines that have been
authorized by OMS for use overseas. Reports from Peace Corps are of special significance
due to the inclusion of vaccines that are not routinely used in the U.S. The PCMO should
consult OMS if a Volunteer has a medical contraindication to vaccination, i.e., history of a
significant reaction to a vaccine or vaccine component.
If adverse event suspected, review the VAERS resource and information below:
o Any event which is specifically required to be reported which occurs within the
specified time period or within seven days of vaccination as defined by the
table Reportable Events Following Vaccination found at:
http://vaers.hhs.gov/resources/VAERS_Table_of_Reportable_Events_Foll
owing_Vaccination.pdf
o Any event listed in the manufacturers package insert as a contraindication to
subsequent doses of the vaccine.
o Any clinically significant adverse event occurring after the administration of
any vaccine. Reporting of an adverse event does not necessarily imply that the
vaccine(s) caused the event.
Contact the EPI Unit if you suspect an adverse reaction as it must be reported on a
VAERS form. The EPI unit will assist the PCMO with reporting adverse reactions.
6. VOLUNTEERS DELINQUENT IN RECEIVING IMMUNIZATIONS

Peace Corps Volunteers must receive all country-specific recommended immunizations at
the proper intervals. A Volunteer who refuses immunization or is consistently delinquent
in receiving immunizations endangers his/her own health as well as the health of others.
Refusal to accept a recommended immunization or prophylaxis is an indication for
mandatory administrative separation. See Manual Section 262; 3.2.
7. SHIPPING AND STORAGE OF VACCINES
Most vaccines, especially live vaccines, are sensitive to heat and light. Some are stable
enough to tolerate short periods of time without refrigeration, while others must remain
refrigerated (or in some cases, frozen) until use. Each manufacturer provides
recommended storage information for the vaccine in the package insert. See also TG 240
Attachment 4 Vaccine Temperature Requirements.
While unrefrigerated shipment of many vaccines is acceptable in the U.S., international
shipments are more likely to encounter wide temperature extremes and longer transport
time. Therefore, all vaccines should be packed in insulated containers with cold packs (or
ice packs for OPV, which must remain frozen) and should arrive with the refrigerant still
cold or frozen. If the cold chain has not been maintained during shipment, PCMOs should
immediately contact the Post Logistical Support (PLS) Division in Washington, DC for
further instructions (see TG 240 Medical Supplies Procurement).
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For maximum reliability of refrigeration, store all vaccines in the interior compartment of
the refrigerator or freezer, never in the doors. Remove only the vaccines necessary for
immediate use and return them to the refrigerator immediately after use.
8. TECHNICAL REFERENCE INFORMATION
This section addresses the most important aspects of individual vaccines included in the
Volunteer immunization program. Some of the vaccines are used on a worldwide basis,
others are used only in certain regions, countries, or areas.
Only adult dosages are included.
ENCEPHALITIS, JAPANESE (JE)

Distribution and Transmission
JE is a mosquito-borne viral disease occurring primarily in rural areas of:
Australia, Bangladesh, Bhutan, Brunei, Burma, Cambodia, China, India, Indonesia, Japan,
North Korea, South Korea, Laos, Malaysia, Nepal, Pakistan, Papau New Guinea, Philippines,
Russia, Singapore, Taiwan, Thailand, Vietnam. Transmission is usually seasonal, primarily
during the rainy season in the tropics and during the summer and fall in temperate areas. See:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6233a2.htm?s_cid=mm6233a2_e#Fig1
For distribution of disease.
Vaccine
Japanese Encephalitis Vaccine is an inactivated Vero cell culturederived vaccine. Ixiaro,
manufactured by Intercell and distributed by Novartis Vaccines, was approved in March 2009.
Imojev (Japanese Encephalitis vaccine) is approved for use by Peace Corps but not available in
the US.
Indications in Volunteers
Japanese Encephalitis vaccine is indicated for Volunteers serving in endemic areas.
Contraindications
A serious allergic reaction after a previous dose of IXIARO is a contraindication to

further doses. The vaccine contains protamine sulfate, a compound known to cause
allergic reactions in some people.
No studies of IXIARO in pregnant women have been conducted. Therefore,

administration of IXIARO to pregnant women usually should be deferred
Adverse Reactions
Local symptoms of pain and tenderness were the most commonly reported symptoms in a
safety study with 1,993 adult participants who received 2 doses of Ixiaro. Headache, myalgia,
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fatigue, and an influenza like illness were each reported at a rate of >10%. Because Ixiaro was
licensed after the study in <5,000 recipients, the possibility of rare serious adverse events
cannot be excluded. Post licensure studies and surveillance are ongoing to further evaluate the
safety of Ixiaro in a larger population.
Ixiaro: 0.5 ml IM on days 0 and 28
Imojev: 0.5 ml IM single dose
Booster Doses
Ixiaro: If primary series >1 year then 0.5 ml booster may be given. See
http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/japaneseencephalitis for updated guidelines on boosters.
Imojev: no booster is needed for 5 years after receiving the Imojev live vaccine
Storage
Unreconstituted vaccine should be stored between 2-8C (36-46F). DO NOT FREEZE. The
reconstituted vaccine should be stored between 2-8C and used within 8 hours. DO NOT
FREEZE.
ENCEPHALITIS, TICK-BORNE (TBE)

TBE is endemic in focal areas of Europe and Asia (from eastern France to northern Japan and
from northern Russia to Albania). From 1990 through 2009, an average of 8,500 cases per year
was reported from 19 European countries. Russia has the largest number of reported TBE cases,
and western Siberia has the highest incidence of TBE in the world. Other European countries
with known endemic areas include Austria, Croatia, Czech Republic, Denmark, Estonia, Finland,
France, Germany, Hungary, Italy, Latvia, Lithuania, Norway, Poland, Romania, Slovakia,
Slovenia, Sweden, and Switzerland. Asian countries with reported TBE cases or virus activity
include China, Japan, Kazakhstan, Kyrgyzstan, Mongolia, and South Korea.
Most cases occur from April through November, with peaks in early and late summer when ticks
are active. The incidence and severity of disease are highest in people aged 50 years. Most
cases occur in areas <2,500 ft (750 m). In the last 30 years, the geographic range of TBEV
appears to have expanded to new areas, and the virus has been found at altitudes up to and above
5,000 ft (1,500 m). These trends are likely due to a complex combination of changes in diagnosis
and surveillance, human activities and socioeconomic factors, and ecology and climate. TBE is
transmitted by tick bites and also by consuming unpasteurized dairy products. The risk to
travelers who do not visit forested areas or consume unpasteurized dairy products is low.
Vaccines
Two inactivated cell culture-derived TBE vaccines are available in Europe, in adult and pediatric
formulations: FSME-IMMUN/TicoVac (Baxter, Austria) and Encepur (Novartis, Germany). The
adult formulation of FSME-IMMUN is also licensed in Canada. Two other inactivated TBE
vaccines are available in Russia: TBE-Moscow (Chumakov Institute, Russia) and EnceVir
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(Microgen, Russia). Immunogenicity studies suggest that the European and Russian vaccines
should provide cross-protection against all 3 TBEV subtypes. For both FSME-IMMUN and
Encepur, the primary vaccination series consists of 3 doses. The specific recommended intervals
between doses vary by country and vaccine. Although no formal efficacy trials of these vaccines
have been conducted, indirect evidence suggests that their efficacy is >95%. Vaccine failures
have been reported, particularly in people aged 50 years.
Vaccination is recommended for Volunteers residing in rural areas or who work outdoors in
endemic areas.*
All Volunteers should be advised to use insect repellent (DEET) and wear appropriate clothing.
Unpasteurized dairy products should not be consumed.
*Endemic areas are well defined in Central Europe. All forested areas in the former Soviet
Union should be considered to be endemic areas unless specific epidemiologic information is
available.
Contrindications
FSME-Immun (Baxter, Canada)
Persons with systemic allergies to eggs should not be vaccinated.
Adverse Reactions
Mild injection site reactions (>10%) and headache, nausea, myalgia, and fatigue (1-10%) may
occur.
0.5 ml intramuscularly in months 0, 1, and 10-12.
Booster Doses
0.5 ml intramuscularly three years after the last dose.
Accelerated Dosing
0.5 ml intramuscularly given on days 0, 7, and 21.
Storage
Store between 2-8C (36-46F). DO NOT FREEZE.
HEPATITIS A (HAV)
HAV infection is highly endemic throughout the developing world, where it is primarily a
childhood infection. Transmission occurs via person-to-person contact or from the ingestion of
contaminated food or water.
Vaccines
Inactivated vaccines are available in the U.S. from GlaxoSmithKline (Havrix) and Merck
(Vaqta). Havrix (GlaxoSmithKline) contains 1440 ELISA units (EL.U.) per dose and Vaqta
(Merck) contains 50 units (U.) per dose. Both vaccines are authorized for use as described
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below. Less potent pediatric formulations (Havrix 720 EL.U./dose, Vaqta 25 U./dose) should
not be used.
One dose of vaccine produces high levels of antibody within four weeks. Immune Globulin
(IG) (see IG section below) may be given in addition to hepatitis A vaccine to provide
immediate protection. IG should be administered during the first month of service in settings
where Trainees will be at significant risk for acquiring hepatitis A before high antibody levels
are achieved from HAV vaccine. A second dose of vaccine is necessary to maintain protection
beyond one year (see below).
All Volunteers must be immunized against HAV infection. Hepatitis A vaccine should be
administered upon arrival unless proof of immunity is present, i.e., positive anti-HAV antibody
titer or documentation of prior vaccination with the hepatitis A vaccine (see above).
Contraindications
Persons allergic to vaccine or any of its components (e.g., alum, 2-phenoxyethanol for Havrix)
should not be vaccinated. IG should be used every four months in such persons.
Adverse reactions
Local pain and tenderness at the injection site, occasional mild systemic symptoms.
Primary immunization
1.0 ml intramuscularly in months 0 and 6. Volunteers should receive the second dose at the
first opportunity for vaccination (six to12 months after first dose).
(If IG is used, it is given 14 days after arrival in country to prevent interaction with MMR
vaccine and must be given at a separate injection site).
Booster Doses
The need for booster doses following the primary series has not been determined. Research has
shown the primary dose to be effective for >25 years (ACIP, 2006).
Storage
Store between 2- 8C (36-46F). DO NOT FREEZE.
Immune Globulin
IG, Gamma Globulin IG is a sterile solution of immunoglobulin (antibodies) prepared from
pooled human plasma. IG offers short-term protection against HAV infection for at least four
months. IG is available for intramuscular injection.
IG may be administered to provide protection during the first month after vaccination and for
person allergic to hepatitis A vaccine. See hepatitis A vaccine information above.
Contraindications
IG should not be given to persons with known immunoglobulin A deficiency. IG should not be
given in patients with a history of prior systemic allergic reactions to IG. IG for intramuscular
use should NEVER BE GIVEN INTRAVENOUSLY..
Adverse reactions
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Local pain and tenderness at the injection site, urticaria, and angioedema may occur following
IG administration. Serious reactions are rare.
How Administered
Short-term protection (less than three months)
2.0 ml intramuscularly is effective for up to 3 months. (0.02 ml/kg)
Long-term protection (more than three months)
5.0 ml intramuscularly is effective for at least four months. (0.06 ml/kg)
Volunteers who cannot receive hepatitis A vaccine should receive IG every four months.
Interactions
IG must be given three months before, or two weeks after, MMR vaccine. IG does not interfere
with yellow fever or polio vaccines.
IG does not produce a clinically significant drop in the response to hepatitis A vaccine and may
be given before, with, or after vaccination.
Storage
IG should be refrigerated at 2- 8C (36-46F). DO NOT FREEZE.
HEPATITIS B (HBV)
Hepatitis B is a disease caused by hepatitis B virus (HBV), a small, circular, partially doublestranded DNA virus in the Hepadnaviridae family.
HBV is moderately to highly endemic in most countries where Volunteers serve. Endemicity
can be classified based on the prevalence of HBV carriers (HBsAg positive) as:
High endemicity (HBsAg prevalence 8-15%)
SE Asia, Central Asia, China, Tropical Africa, Pacific Islands, Amazon Basin;
Intermediate endemicity (HBsAg prevalence 2-7%)
Central Europe, Mediterranean, Central and Tropical South America, Haiti, the
Dominican Republic, Middle East, India, Russia; Low endemicity (HBsAg prevalence <02%)
North America, Western Europe, Australia, New Zealand, Temperate South America.
HBV transmission occurs via percutaneous or permucosal exposure to infected blood or bloodderived fluid, especially occupational blood exposure, exposure to contaminated needles or
blood, and perinatal and sexual transmission.
Approximately 5% of U.S. residents become infected with HBV during their lives, most often
during young adulthood.
Vaccines
Recombinant hepatitis B vaccines are produced by yeast cultures into which the gene for
hepatitis B surface antigen (HBsAg) has been inserted. Vaccines are available in the U.S. from
Merck (Recombivax HB) and Glaxo SmithKline (Engerix-B). Additionally, a combined
hepatitis A and B vaccine is available from Glaxo SmithKline (Twinrix).
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Immunization
Protective antibodies are produced in more than 90% of healthy young adults. Vaccine
response rates decrease somewhat with age (see below).
Universal vaccination of all Volunteers is required. The majority of Volunteers serve in areas
of intermediate to high HBV endemicity*. In addition, sexually active adults benefit from
vaccination. Pre-service is required to document the status of anti-HBs. If it is negative, the
Volunteer should repeat the primary series (of 3 vaccinations) OR the PCMO may repeat the
sAB test one month after vaccination; if negative, continue the two shots to complete the
series.
Contraindications
Hypersensitivity to any component of the vaccine is a contraindication to its use. There is no
apparent risk of adverse events to developing fetuses when hepatitis B vaccine is administered
to pregnant women.
Adverse Reactions
Hepatitis B vaccines have been shown to be safe when administered to both adults and
children. The major side-effects have been soreness and redness at the site of injection.
Recombivax HB, Engerix-B
1.0 ml intramuscularly (deltoid only) in months 0, 1, and 6.
Accelerated: 1.0 ml IM months 0, 1, and 2 with a booster at 12 months
Recombivax HB and Engerix-B may be interchanged without affecting vaccine response.
Twinrix
1.0 ml IM in months 0, 1, and 6
Accelerated; 1.0 ml IM on days 0, 7, 21-30, and a booster at 12 months
Serologic testing one to two months after completing all doses to confirm vaccine response
(defined as antibody to hepatitis B surface antibody [anti-HBS] concentration > 10 mIU/mL) is
recommended by OMS for health care workers and others at occupational risk of HBV
infection. Additional doses of vaccine may be necessary. See CDC recommendations for more
information.
Booster Doses
Additional booster doses are not recommended for healthy adults for the standard dosing;
boosters necessary for accelerated dosing.
Storage
Vaccine should be refrigerated at 2- 8C (36-46F). DO NOT FREEZE. Freezing destroys the
potency of the vaccine.
INFLUENZA
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Influenza is caused by infection of the respiratory tract with influenza viruses, which are
classified into 3 types: A, B, and C. Only virus types A and B, however, commonly cause illness
in humans. Influenza A(H1N1), A(H3N2), and influenza B viruses currently circulate globally
among humans. Information on current circulating virus strains in various regions can be found
via CDC (www.cdc.gov/flu/weekly/fluactivitysurv.htm) or the World Health Organization
(www.who.int/influenza).
Vaccines
In the Northern Hemisphere, an influenza vaccine (inactivated virus) is available each fall to
provide protective antibodies against the influenza subtypes most likely to be found the
following winter. Antigens from several influenza A strains and one influenza B strain are
generally included.
Vaccines appropriate for use in the Southern Hemisphere may differ from those distributed in
the U.S. Consult local health authorities for advice about the source and composition of
vaccine recommended for individual countries. Vaccines manufactured in the U.S. may be
used when a more specific vaccine is not available.
All volunteers should be vaccinated.
Adverse Reactions
Local reaction of varying degrees may occur. These range from burning or stinging on
injection to local induration, tenderness, and erythema lasting one to two days. Systemic
reactions of myalgia, fever, headache, and malaise also occur. Guillain-Barre syndrome has
been reported to be a rare complication of some influenza vaccines.
0.5 ml intramuscularly in the deltoid muscle. One dose is given each fall. A needle of length
one inch or more should be considered for adults, as needles < 1 inch may be of insufficient
length to penetrate muscle tissue.
Storage
MEASLES-MUMPS-RUBELLA
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Measles (rubeola), mumps, and rubella are common diseases in developing countries. Measles
and occasionally mumps produce severe complications in adults, while rubella infections
during pregnancy are associated with miscarriage and with adverse effects on the fetus
(congenital rubella syndrome).
Vaccine
MMR vaccine is a combination of three live-attenuated virus vaccines. The measles and
mumps components are grown in chick embryo cell cultures. The rubella vaccine is grown on
human diploid cell cultures.
A single dose of MMR vaccine given in childhood has been shown to protect approximately
95% of those vaccinated. Completion of two doses of MMR vaccine is recommended for all
children and for adults at increased risk of exposure to measles and rubella (including
international travelers).
All Volunteers are to receive MMR vaccine unless:
can provide documentation of two doses of MMR, often required for entrance to college or
given for international travel in the past; or
they were born before 1957* (except GHSP Volunteers)
can provide serologic proof of immunity to measles, mumps, and rubella
* 1957 determined by the CDC
GHSP Volunteers: must provide documentation of two doses of MMR or provide serologic
proof of immunity
Documented age-appropriate vaccination supersedes the results of subsequent serologic
testing. If a person who has 2 documented doses of measles- or mumps-containing vaccines is
tested serologically and is determined to have negative or equivocal measles or mumps titer
results, it is not recommended that the person receive an additional dose of MMR vaccine. i
Contraindications
MMR should not be given to pregnant women and pregnancy should be avoided for three
months after vaccination. MMR contains small amounts of neomycin and should not be given
to persons who have had anaphylactic reactions to neomycin. Any person with reduced
immunity should not receive the vaccine. MMR should not be given to persons who have had
anaphylactic reactions to gelatin or gelatin-containing products. Individuals with a severe
hypersensitivity to eggs should not be given vaccine. Persons who can eat eggs or eggcontaining foods without adverse effects can be vaccinated safely.
Interactions
Immune Globulin
Immune Globulin (IG) must be given three months before, or two weeks after, MMR vaccine.
Repeat MMR vaccine if IG administered less than three months before, or less than two weeks
after, MMR vaccination.
Live Vaccines
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MMR and yellow fever vaccines (and other live vaccines except oral typhoid vaccine) must be
given either on the same day or four weeks apart. Oral typhoid vaccine and all inactivated
vaccines may be given anytime before, with, or after MMR vaccine.
Adverse Reactions
Measles vaccine
Fever greater than 39C (103F) is seen in approximately 5-15% of those vaccinated, usually
beginning between the 5th and 12th days after vaccination and lasting for one to two days.
Transient rashes occur in approximately 5% of vaccines.
Up to 55% of persons who were vaccinated with killed measles vaccine during 1963-1967
experience a local or mild systemic reaction after live measles vaccination. Occasionally illness
may be more severe but is much milder than that seen with atypical measles (measles which
occurs in persons who are partially immune).
Mumps vaccine
Parotitis and encephalitis have been reported rarely. Revaccination is not associated with
increased adverse effects.
Rubella vaccine
Adverse events are only seen in persons without previous vaccination or natural infection (i.e.,
no rubella immunity). Up to 40% of susceptible adults experience joint pains in the small
joints, knees, or both. Women are more often affected than are men or children. Symptoms
appear one to three weeks after vaccination and generally persist for one day to three weeks.
Chronic joint complaints following vaccination are generally rare and occur at a rate
considerably less than that following natural infection. Transient peripheral neurologic
complaints are also reported rarely.
MMR 0.5 ml subcutaneously, two doses given at least one month apart.
Long lasting protection is obtained in 95% of vaccinated persons after one dose and 100% after
two doses of MMR.
Booster Dose
Immunity following two doses of MMR vaccine is long lasting. Additional doses are not
required.
Vaccine Storage
Store vaccine at 2-8C (36-46F). Protect from light. Store reconstituted vaccine at 2-8C,
protect from light, and use within eight hours.
MENINGOCOCCAL VACCINE
N. meningitidis is found worldwide. At any time, 5%10% of the population may be carriers of
N. meningitidis. Invasive disease is rare in nonepidemic areas, occurring at a rate of 0.510
cases per 100,000 population per year, but can occur at a rate of up to 1,000 cases per 100,000
population per year in epidemic regions. The incidence of meningococcal disease is several
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times higher in the meningitis belt in Africa (stretching from The Gambia to Ethiopia) than in
the United States, with periodic epidemics during the dry season (DecemberJune). During
nonepidemic periods, the rate of meningococcal disease in this region is roughly 510 cases
per 100,000 population per year. During epidemics, the rate can be as high as 1,000 cases per
100,000 population. Serogroup A predominates in the meningitis belt, although serogroups C,
X, and W-135 are also found. Transmission is by direct person-to-person spread of bacteria
from nasal and pharyngeal secretions (most infected persons remain asymptomatic or have
only a mild respiratory illness).
Vaccine
Two quadrivalent meningococcal polysaccharideprotein conjugate vaccines are licensed for
use in the United States: Menactra (Sanofi Pasteur) and Menveo (Novartis). A 1-dose primary
series of Menactra is licensed for people aged 255 years; a 2-dose primary series of Menactra
is licensed for children aged 923 months. Menveo is licensed for people aged 255 years.
Quadrivalent meningococcal polysaccharide vaccine (Menomune, Sanofi-Pasteur) is licensed
for use among people aged 2 years. These vaccines protect against meningococcal disease
caused by serogroups A, C, Y, and W-135. A vaccine was licensed in the US (Trumenba) for
meningococcus B. Approximately 710 days are required after vaccination for development of
protective antibody levels. Either of the conjugate vaccines is preferred for people aged 255
years; polysaccharide vaccine should be used for people >55 years.
Volunteers serving in areas experiencing epidemic or highly endemic meningococcal disease in
Africa should be immunized. ACIP recommends that children previously vaccinated at ages 9
months through 6 years who remain at an increased risk for meningococcal disease receive an
additional dose of conjugate vaccine 3 years after their previous meningococcal vaccine and
every 5 years thereafter, if at continued risk. Likewise, people who were previously vaccinated
at ages 755 years and who remain at an increased risk for meningococcal disease should
receive an additional dose of conjugate vaccine 5 years after their previous dose and every
5 years thereafter, if at continued risk. Travelers aged >55 years should be vaccinated or
revaccinated with polysaccharide vaccine if it has been >5 years since their last meningococcal
vaccine. Previously unvaccinated travelers <56 years of age who have a history of complement
component deficiency (C3, properdin, factor D, or late component), functional or anatomic
asplenia, or HIV should receive a 2-dose primary series of conjugate vaccine, 812 weeks
apart. For those aged 56 years with these conditions, a single dose of polysaccharide vaccine
should be given before travel if possible.
Contraindications
People with moderate or severe acute illness should defer vaccination until their condition
improves. Vaccination is contraindicated for people who have severe allergic reaction to any
component of the vaccines. People with dry natural rubber latex allergy should not receive
Menactra. Polysaccharide vaccine is an acceptable alternative for protection against
meningococcal disease in these people. All meningococcal vaccines are inactivated and may be
given to immunosuppressed people.
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Adverse reactions
Local reactions such as pain, tenderness, induration, and erythema may occur.
0.5 ml subcutaneously (Menomune)/ 0.5 ml intramuscular (Menactra/ Menveo)
Booster Doses
A booster dose after 3 years is indicated if at continued risk.
Storage
Store freeze-dried and reconstituted vaccine between 2-8C (36-46F). Discard reconstituted
vaccine after 24 hours (single dose vial) or after five days (multi-dose vial).
PNEUMOCOCCAL VACCINE
Pneumococcal pneumonia is the most common post-viral bacterial pneumonia, and is a
significant cause of morbidity in areas where epidemic influenza or a high incidence of
respiratory diseases occurs.
Vaccine
A meta-analysis of 15 randomized controlled trials (RCTs) and seven nonrandomized
observational studies of PPSV23 efficacy and effectiveness suggested an overall efficacy of 74%
against IPD (CI = 56%--85%), based on pooled results of 10 of the RCTs.
Volunteers meeting any of the following criteria are to be vaccinated prior to PC service.
However, if a Volunteer is not able to be immunized prior to service, PC should provide the
vaccine for him/her:
>65 OR will be turning 65 during PC service
Chronic heart disease (excluding hypertension)
Chronic lung disease, including asthma
Diabetes Mellitus
Cochlear implant
Cigarette smoking
Sickle cell disease and other hemoglobinopathies
Congenital or acquired asplenia, splenic dysfunction, or splenectomy
Congenital or acquired immunodeficiencies
HIV infection
Diseases requiring treatment with immunosuppressive drugs, including long-term
systemic corticosteroids or radiation therapy
Contraindications
The safety of pneumococcal polysaccharide vaccine among pregnant women has not been
evaluated. Women at high risk of pneumococcal disease ideally should be vaccinated before
becoming pregnant.
Adverse Reactions
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About half of persons vaccinated experience mild side effects such as erythema and pain at the
site of injection. Fever, myalgias and severe local reactions have been reported by <1% of
recipients. Anaphylactic reactions are rare.
0.5 ml subcutaneously or intramuscularly (one dose)
Booster Doses
Revaccination is recommended one time 5 years after the first dose for persons who are
asplenic and for chronic renal failure, nephrotic syndrome, and organ transplant recipients.
Revaccination is also recommended over age 65 if they were vaccinated when they were <65
years of age. An interval of at least five years should be maintained between doses of PPSV23.
Storage
Store between 2-8C (36-46F).
POLIO
Polio is endemic in some parts of the world. See
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx for reference.
Transmission is primarily by direct contact via fecal-oral contamination or contact with
pharyngeal secretions.
Vaccines
Completion of a primary series provides >95% immunity to all three polioviruses.
Inactivated Polio Vaccine (IPV)
Inactivated polio vaccine (IPV) should be used for the primary immunization of adults.
Oral polio vaccine (OPV) is an alternative only if IPV is unavailable.
Volunteers who have completed a primary series should receive one booster dose of IPV after
the age of 18 or provide proof of documented immunity.
Contraindications
IPV may be given to pregnant women if immediate protection against poliomyelitis is needed.
IPV may be given to persons who are immunocompromised, their household members or other
close contacts.
Oral Polio Vaccine (OPV)
Pregnant women and persons who are immunocompromised should not be vaccinated with
OPV. Household contacts of immunocompromised persons should not be vaccinated with
OPV.
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Adverse Reactions
IPV has had no serious side effects documented. IPV contains trace amounts of streptomycin
and neomycin and hypersensitivity reactions are possible among persons sensitive to these
antibiotics.
Oral Polio Vaccine (OPV)
There is a small (about two per million) risk of paralytic polio occurring in first-dose vaccine
recipients or their contacts.
Primary series
Volunteers whose primary immunization is in doubt should receive IPV, 0.5 ml
subcutaneously in months 0, 1, and 2.
Booster doses
One booster dose is required after the age of 18.
IPV 0.5 ml subcutaneously
(If OPV must be used, the booster dose is 0.5 ml orally)
Storage
IPV
RABIES
Rabies is endemic in most countries. Virus-infected saliva from a rabid animal may be
introduced through a bite wound, or very rarely through broken skin or through intact mucous
membrane exposure.
Vaccines
Human Diploid Cell Vaccine (HDCV), Rabies Vaccine Adsorbed (RVA), and Purified Chick
Embryo Cell (PCEC) vaccines are approved for use in the U.S. RVA or PCEC are appropriate
for persons allergic to HDCV. Verorab is a vaccine manufactured overseas that is approved for
use in PC. Intradermal vaccines are not approved for use by PC.
Pre-exposure Prophylaxis
Volunteers in countries where rabies is highly endemic are to receive pre-exposure
immunization (see below) in addition to instructions on cleansing wounds and on the need for
post-exposure prophylaxis with rabies vaccine.
Volunteers in countries with low rabies endemicity where contact with stray animals is
common are also recommended to receive pre-exposure prophylaxis to simplify post-exposure
treatment and to avoid use of potentially hazardous vaccines available locally.
Volunteers in countries with low rabies endemicity and little contact with stray animals and
where access to post-exposure rabies vaccine and rabies immune globulin (human) is reliable
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do not need to be given pre-exposure vaccine. They must be instructed on cleansing wounds
and on the need for post-exposure prophylaxis (rabies vaccine and rabies immune globulin),
which must be stocked for at least two complete treatment doses (immune globulin + 4 IM
vaccines).
Post-exposure Prophylaxis
All animal bites and scratches should immediately be thoroughly washed with soap and water.
Many species of mammals have been documented to transmit rabies via bites and scratches
including bats, dogs, cats, skunks, foxes, coyotes, raccoons, bobcats, and other carnivores. In
endemic areas, if the animal is suspected to be rabid, the bitten Volunteer should be vaccinated
unless the animal is proven to be rabies negative by rabies testing. Vaccination should also
occur when a bite cannot be reasonably excluded; such as during sleep, when the victim is
intoxicated, or when the victim cannot clearly communicate, e.g., a child. Bites from livestock,
rodents, rabbits, and hares rarely require vaccination.
Contraindications
Persons with a history of hypersensitivity to eggs to PCEC. Persons with a history of
hypersensitivity to HDCV, RVA, or PCEC.
Adverse Reactions
Local reactions such as pain, erythema, and swelling or itching at the injection site are
frequently reported. Mild systemic reactions such as headache, nausea, abdominal pain, muscle
aches and dizziness also occur. Serious anaphylactic, systemic or neuroparalytic reactions are
extremely rare.
Up to 6% of persons receiving booster vaccination with HDCV experience urticaria, pruritus,
and malaise (immune complex-like reaction).
Interactions
Corticosteroids and other immunosuppressive agents can interfere with the development of
active immunity and should not be administered during pre-exposure therapy.
Pre-exposure immunization
HDCV/ PCEC/ RVA: 1.0 ml intramuscularly on days 0, 7, and 21* or days 0, 7, and 28.
Verorab: 0.5 ml intramuscularly on days 0, 7, and 21 or days 0, 7, and 28
*The 21 day schedule is preferred for Volunteers serving in highly rabies endemic areas.
Rabies vaccine is effective if intervals between doses are longer than those listed, however the
onset of an adequate response would be delayed. For this reason, all three doses should be
completed within 21-28 days whenever possible.
Booster Immunization
In general, OMS recommends rabies boosters for Volunteers 3-5 years once the primary series
has been completed. US DoS does not recommend a one year booster with Verorab.
Immunization of PCV animals
PCVs that possess animals should be highly encouraged to vaccinate their pet against rabies.
Post-Exposure Immunization
Completed 3-dose primary series (IM)
1.0 ml intramuscularly on days 0 and 3. Rabies immune globulin (RIG) should not be given.
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Incomplete or no primary series

Volunteers who have not completed all three doses of HDCV, RVA, or PCEC must receive:
Rabies immune globulin, human (HRIG) 20 IU/kg; as much as possible infiltrated at bite
site and the remainder given IM. (Note: Anti-rabies serum, equine, is a horse serum
preparation that can be associated with severe adverse reactions and must be avoided).
1.0 ml IM on days 0, 3, 7, and 14
NOTE: Volunteers should be instructed during pre-service training to never to allow any
local facility to administer any form of rabies immunization. Several potentially dangerous
vaccines are routinely used abroad. Volunteers should be instructed to contact the PCMO
immediately after possible exposure to rabies.
Vaccine Storage
HDCV rabies vaccine should be stored under refrigeration at 2- 8C (35- 46F). DO NOT
FREEZE. Unused reconstituted vaccine should be discarded if not used within 24 hours.
TETANUS, DIPHTHERIA and PERTUSSIS
Tetanus, an acute disease caused by Clostridium tetani, is characterized by muscle rigidity and
painful spasms, often starting in the muscles of the jaw and neck. Severe tetanus can lead to
respiratory failure and death. The disease is caused by a neurotoxin produced by anaerobic
tetanus bacilli growing in contaminated wounds. Lesions that are considered tetanus prone are
wounds contaminated with dirt, feces or saliva, deep wounds, burns, crush injuries, or those with
necrotic tissue. However, tetanus has also been associated with apparently clean superficial
wounds, surgical procedures, insect bites, dental infections, chronic sores and infections, and
intravenous drug use. In 10% of reported cases in the United States, no antecedent wound was
identified.
Diphtheria is an acute bacterial disease caused by toxigenic strains of Corynebacterium
diphtheriae. The disease affects the mucous membranes of the respiratory tract (respiratory
diphtheria), the skin (cutaneous diphtheria), and occasionally mucous membranes at other sites
(eyes, ears, or vagina). Cutaneous diphtheria is common in tropical countries. Humans are the
only known reservoir of C. diphtheriae. Diphtheria is transmitted to close contacts by respiratory
droplets or by direct contact with discharge from skin lesions, and rarely from fomites. Raw
milk or dairy products have been reported as vehicles for transmission.
Pertussis (Whooping Cough) causes severe coughing spells, vomiting, and disturbed sleep. It is
caused by the bacterium Bordetella pertussis, which is a highly communicable respiratory illness
characterized by prolonged paroxysmal coughing. Persons in all age groups can be infected.
Complications and deaths from pertussis are most common among unvaccinated infants.
Vaccine
In 2005, two tetanus toxoid, reduced diphtheria, and acellular pertussis (Tdap) vaccine products
were licensed for use by the FDA. BOOSTRIX (GlaxoSmithKline Biologicals) and ADACEL
(Sanofi Pasteur) are licensed for use in persons aged 10-18 and 11-64 years, respectively.
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Adolescents aged 11-18 years who have completed their childhood vaccination series with DT,
DTaP and/or DTwP should receive a single dose of Tdap instead of Td for booster immunization
against tetanus as well as diphtheria and pertussis. Adults aged 19-64 years who have not
previously received Tdap should receive a single dose of Tdap if their last dose of tetanus toxoidcontaining vaccine was administered more than 10 years prior. Tdap is not licensed or
recommended for adults older than 65 years, who should receive Td instead.
Anyone who has received only one or two prior doses of tetanus and diphtheria toxoids should
receive additional does to complete the three-dose series. A single dose of Tdap can be
substituted for any of the Td doses.
Contraindications
An immediate anaphylactic reaction to a prior dose of vaccine or vaccine component is a
contraindication to further vaccination with DTaP, DT, or adult Td or Tdap. Encephalopathy not
due to another identifiable cause within 7 days of vaccination is a contraindication to further
vaccination with a pertussis-containing vaccine. DT or Td may be substituted for DTaP or Tdap,
respectively. Moderate or severe acute illness is a precaution to vaccination. Mild illnesses, such
as otitis media or upper respiratory infection, are not contraindications. Anyone for whom
vaccination is deferred because of moderate or severe acute illness should be vaccinated when
the condition improves.
Adverse Reactions
Local reactions such as local redness, induration, and tenderness are common, particularly
among persons who have received multiple boosters of tetanus toxoid. Systemic reactions such
as malaise and fever are less common. Rarely, neurologic complications following
administration of tetanus toxoid have been reported.
Adolescents or adults who have never been immunized against tetanus, or whose immunization
history is uncertain, should receive a three-dose series of vaccinations. The preferred schedule is
a single Tdap dose, followed by a dose of Td 4-8 weeks after the Tdap dose, and a second dose
of Td 6-12 months after the first Td dose; however, a single dose of Tdap can be substituted for
any one of the three doses in the series.
Booster Doses
Anyone who has received only one or two prior doses of tetanus and diphtheria toxoids should
receive additional doses to complete the three-dose series. A single dose of Tdap can be
substituted for any of the Td doses. The Td or Tdap vaccine must be given stateside within the
past seven years prior to departure (will cover volunteer for up to ten years or three in service). ii
NOTE: Volunteers should be instructed during pre-service training never to allow any local
facility to administer any form of tetanus immunization. Several potentially dangerous vaccines
are routinely used abroad.
Storage
Tetanus diphtheria toxoid vaccine (Td) and Tetanus, diphtheria and pertussis (Tdap) should be
stored between 2- 8C (35- 46F). DO NOT FREEZE. Discard if the vaccine has been frozen.
Do not use after expiration date shown on the label.
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TYPHOID FEVER
Typhoid fever is caused by infection with Salmonella typhi through exposure to contaminated
food and water. It is endemic throughout Africa, Asia, and Central and South America.
Vaccines
Two newer vaccines that are as effective and better tolerated than the older heat-phenol
inactivated vaccine are now available.
Vi capsular polysaccharide vaccine (ViCPS)
ViCPS vaccine is the preferred vaccine for overseas use because of the single dose
convenience, reasonable cost, and less stringent shipping requirements. Typhim Vi is
manufactured by Pasteur Merieux and distributed in the U.S. by Connaught.
Oral typhoid vaccine (Ty21a)
Ty21a is a live attenuated bacterial vaccine that is well tolerated; however in-country
vaccination is more difficult due to multiple dose issues, shipping requirements, and the need
to defer vaccination during episodes of acute gastrointestinal illness and antibiotic use.
All Volunteers should be vaccinated except those serving in countries without risk of typhoid
(i.e., most of Northern Europe).
Even after vaccination, food and water should be selected carefully. A large inoculum of
Salmonella typhi may overwhelm the protective effect of the vaccine.
Contraindications
Contraindicated in patients with a history of hypersensitivity to this vaccine.
Not recommended for children under six years of age or immunocompromised persons
(including those with asymptomatic HIV infection). Vaccination should be deferred in
individuals with an acute febrile or gastrointestinal illness.
Adverse Reactions
Mild local reactions may occur. ViCPS vaccine is most often associated with headache (16%
20%) and injection-site reactions (7%).
Adverse reactions to Ty21a vaccine are rare and mainly consist of abdominal discomfort, nausea,
vomiting, and rash.
Interactions
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It should be taken at least 24 hours before or after antibiotics, sulfonamides (including

Diamox), or mefloquine.
It should not be given in individuals who are immunocompromised or asplenic.
Ty21a may be administered together with live viral vaccines or immune globulin if necessary.
Primary Immunization and Booster Doses
0.5 ml intramuscularly (one dose)
Repeat every two years if at continued risk (optional for volunteers completing regular tour;
required if extending or planning COS trip)
One tablet by mouth taken with cool liquid on days 0, 2, 4, and 6
Repeat the four-dose series every five years if at continued risk
Storage
Store between 2- 8C (35- 46F). DO NOT FREEZE.
Vaccine capsules should be refrigerated at 2-8C (35F to 46F) at all times until consumed.
DO NOT FREEZE. Cold chain must be highly reliable during shipment and storage.
VARICELLA VACCINE
Varicella occurs worldwide. In temperate climates, varicella tends to be a childhood disease,
with peak incidence among preschool and school-aged children and during late winter and early
spring. In tropical climates, infection tends to occur later during childhood and adolescence,
resulting in higher susceptibility among adults than in temperate climates.
Varicella vaccine is routinely used to vaccinate healthy children in only some countries,
including the United States. With the implementation of the varicella vaccination program in the
United States, substantial declines have occurred in disease incidence, and although varicella is
still endemic, the risk of exposure to varicella zoster virus is higher in most other parts of the
world than it is in the United States. Varicella-zoster virus is transmitted from person to person
by direct contact, inhalation of aerosols from vesicular fluid of skin lesions of varicella or herpes
zoster, or from infected respiratory tract secretions that might also be aerosolized. The varicella
zoster virus enters the host through the upper respiratory tract or the conjunctiva. The period of
communicability is estimated to begin 12 days before the onset of rash and ends when all
lesions are crusted, typically 47 days after onset of rash in immunocompetent people, but this
period may be longer in immunocompromised people. People with varicella should be isolated
for as long as lesions persist.
Vaccine
Evidence of immunity should be determined pre-service and includes any of the following:
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Documentation of age-appropriate vaccination:

o
School-aged children, adolescents, and adults: 2 doses
Laboratory evidence of immunity or laboratory confirmation of disease
Birth in the United States before 1980 (not a criterion for Global Health Service
Partnership Volunteers and immunocompromised people)
All Volunteers should be vaccinated or demonstrate immunity to Varicella.
Contraindications
People with contraindications for varicella vaccine should not receive varicella vaccine,
including anyone who
has a history of anaphylactic/anaphylactoid reaction to gelatin, neomycin, or any other

component of the vaccine
has a moderate or severe concurrent illness
has received blood products (such as whole blood, plasma, or immune globulin) during
the previous 3 to 11 months, depending on dosage
Adverse reactions
The most commonly reported health problems after vaccination were rash, fever, and pain,
redness, and soreness at the injection site
Varicella vaccine contains live, attenuated varicella-zoster virus. CDC recommends varicella
vaccination for all people aged 12 months without evidence of immunity to varicella who do
not have contraindications to the vaccine: 2 doses for people aged 4 years. The minimum
interval between doses is 4 weeks for people aged 13 years. When evidence of immunity is
uncertain, a possible history of varicella is not a contraindication to varicella vaccination.
Booster Doses
Immunity following two doses of Varicella vaccine is long lasting. Additional doses are not
required.
Storage
For potency to be maintained, the lyophilized varicella vaccines must be stored frozen at an
average temperature of 5F (-15C) or colder. Diluent should be stored separately either at room
temperature or in the refrigerator. Vaccines should be reconstituted according to the directions in
the package insert and only with the diluent supplied with the vaccine, which does not contain
preservative or other antiviral substances that could inactivate the vaccine virus. Once
reconstituted, vaccine should be used immediately to minimize loss of potency. Vaccine should
be discarded if not used within 30 minutes after reconstitution.
June 2016
Page 27
TG 300
Immunization
YELLOW FEVER
Yellow fever occurs in sub-Saharan Africa and tropical South America, where it is endemic
and intermittently epidemic. Most yellow fever disease in humans is due to sylvatic (jungle) or
intermediate (savannah) transmission cycles. However, urban yellow fever occurs periodically
in Africa and sporadically in the Americas. In Africa, natural immunity accumulates with age,
and thus, infants and children are at highest risk for disease. In South America, yellow fever
occurs most frequently in unimmunized young men who are exposed to mosquito vectors
through their work in forested areas.
Vaccine
Yellow Fever vaccine is an attenuated live virus vaccine grown in chick embryos. Immunity is
induced by a single subcutaneous (SC) injection of 0.5 ml of reconstituted vaccine and persists
for at least ten years.
Yellow fever vaccines should be administered at an official yellow fever vaccination center
and validated by an official stamp. PCMOs may reimburse currently-serving volunteers who
go to local facilities to get vaccinated for the cost of the vaccine & visit only (not travel to
clinic). If a clinic is not available, the responsibility lies with the Volunteer.
(1) Volunteers serving in countries with a risk of yellow fever transmission (yellow fever
endemic areas).
(2) Volunteers who are required to have a certificate of vaccination for entry into their country
of service or are planning to travel to a country that requires the vaccine. PCMO should not
store YF vaccine. PCVs should receive the immunization in an approved facility, if available.
As proof of receipt of YF vaccine, all vaccinees should possess a completed International
Certificate of Vaccination or Prophylaxis (ICVP), validated with the provider's signature and
official YF vaccination center stamp. An ICVP must be complete in every detail; if it is
incomplete or inaccurate, it is not valid. Failure to secure validations can cause a traveler to be
quarantined, denied entry, or possibly revaccinated at the point of entry to a country.
Volunteers with either of these indications should be vaccinated unless they have been
vaccinated within the past seven years.
Contraindications
Allergy to vaccine component (eggs, egg products, chicken proteins, or gelatin.) The
stopper used in vials of vaccine also contains dry natural latex rubber, which may
cause an allergic reaction
Thymus disorder associated with abnormal immune function
Primary immunodeficiencies
Malignant neoplasms
Transplantation
Immunosuppressive and immunomodulatory therapies.
Precautions
June 2016
Page 28
TG 300
Immunization
Age > 60 years: assess Volunteer and give vaccine if healthy; defer if immunecompromised
Asymptomatic HIV infection and CD4 T-lymphocytes 200-499/mm3
Pregnancy
Breastfeeding
Interactions
Yellow fever vaccine must be given simultaneously with, or more than four weeks before or
after MMR. It does not interact with OPV or oral typhoid vaccine.
Adverse Reactions
Common adverse reactions
Reactions to yellow fever vaccine are generally mild; 10%30% of vaccinees report mild
systemic adverse events. Reported events typically include low-grade fever, headache, and
myalgias that begin within days after vaccination and last 510 days. Approximately 1% of
vaccinees temporarily curtail their regular activities because of these reactions.
Severe adverse reactions
Hypersensitivity
Immediate hypersensitivity reactions, characterized by rash, urticaria, bronchospasm, or a
combination of these, are uncommon. Anaphylaxis after yellow fever vaccine is reported to
occur at a rate of 1.8 cases per 100,000 doses administered.
Yellow fever vaccineassociated neurologic disease (YEL-AND)
YEL-AND represents a conglomerate of different clinical syndromes, including
meningoencephalitis, Guillain-Barr syndrome, acute disseminated encephalomyelitis, and
rarely, bulbar and Bell palsies. Historically, YEL-AND was seen primarily among infants as
encephalitis, but more recent reports have been among people of all ages.
The onset of illness for documented cases is 328 days after vaccination, and almost all cases
were in first-time vaccine recipients. YEL-AND is rarely fatal. The incidence of YEL-AND in
the United States is 0.8 per 100,000 doses administered. The rate is higher in people aged 60
years, with a rate of 1.6 per 100,000 doses in people aged 6069 years and 2.3 per 100,000 doses
in people aged 70 years.
Yellow fever vaccineassociated viscerotropic disease (YEL-AVD)
YEL-AVD is a severe illness similar to wild-type disease, with vaccine virus proliferating in
multiple organs and often leading to multisystem organ failure and death. Since the initial cases
of YEL-AVD were published in 2001, >60 confirmed and suspected cases have been reported
throughout the world.
YEL-AVD has been reported to occur only after the first dose of yellow fever vaccine; there
have been no reports of YEL-AVD following booster doses. The median time from YF
vaccination until symptom onset for YEL-AVD cases was 4 days (range, 08 days). The caseOffice of Health Services
June 2016
Page 29
TG 300
Immunization
fatality ratio for all reported YEL-AVD cases worldwide is 63%. The incidence of YEL-AVD in
the United States is 0.4 cases per 100,000 doses of vaccine administered. The rate is higher for
people aged 60 years, with a rate of 1.0 per 100,000 doses in people aged 6069 years and 2.3
per 100,000 doses in people aged 70 years.
0.5 ml subcutaneously (one dose).
Booster Doses
Some countries consider one dose to be valid for a lifetime. See ATTACHMENT A for list of
countries. Others require a booster every 10 years.
Storage
Yellow Fever Vaccine must be stored frozen and used within 60 minutes of reconstitution.
REFERENCES
Advisory Committee on Immunization Practices (ACIP) website:
http://www.cdc.gov/vaccines/acip/index.html
Centers for Disease Control and Prevention (CDC). Health Information for International Travel,
2016. Available online at: http://wwwnc.cdc.gov/travel/yellowbook/2016/table-of-contents
Centers for Disease Control and Prevention (CDC). Epidemiology and Prevention of VaccinePreventable Diseases. 13th Edition. 2015; Available online at:
http://www.cdc.gov/vaccines/pubs/pinkbook/index.html
World Health Organization; Alert, response, and capacity building under the International Health
Regulations (IHR). Available online at: http://www.who.int/ihr/en/index.html
i
MMWR / June 14, 2013 Vol. 62 . No 4

Hammerlund E, Thomas A, Poore EA, et al. Durability of vaccine-induced immunity against tetanus and
diphtheria toxins: a cross sectional analysis. Clin Infect Dis 2016;62:1111-1118.
ii
June 2016
Page 30
Vaccines obtained pre-service and in-service

Post/ Country
Hepatitis A Hepatitis B
As of July 2016
Albania
Armenia
Belize
Benin
Botswana
Burma
Burkina Faso
Cambodia
Cameroon
China
Colombia
Comoros
Costa Rica
Dominican Republic
Eastern Caribbean
Ecuador
Ethiopia
Fiji
Georgia
Ghana
Guatemala
Guinea
Guyana
Indonesia
Jamaica
Kenya
Kosovo
Kyrgyz Republic
Lesotho
Liberia
Macedonia
Madagascar
Malawi
Mali
Mexico
Micronesia
Moldova
Mongolia
Morocco
Mozambique
Namibia
Nepal
Nicaragua
Panama
Paraguay
Peru
Philippines
Rwanda
Samoa
Senegal
Sierra Leone
South Africa
Swaziland
Tanzania
Thailand
The Gambia
Timor L'este
Togo
Tonga
Ukraine
Uganda
Vanuatu
Zambia
1 Volunteers going to Africa need
to provide proof of immunity to
polio or childhood series+
booster; Elsewhere presumed
immunity may be adequate (if
attended public school in US/
military)
2 L means a YF vaccine is valid
for a lifetime
3 B means rabies is found in bats;

countries must provide postexposure prophylaxis if they do
not give pre-exposure prophylaxis
for PCVs in case of bat bite
Updated July 2016
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Measles,
Mumps and
Rubella
Polio
Pneumococcal
Tetanus
Diphtheria
and
Pertussis/
TD
Varicella
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Yellow
Fever2
L
X
L
X
L
X
L
X
L
X
L
X
X
L
L
X
L
X
X
L
X
L
L
X
L
X
L
Rabies
B
X
X
X
X
X
X
X
X
X
X
X
B
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
B
X
X
X
X
Meningococcal
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Influenza
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Japanese
Encephalitis
X
X
X
Typhoid
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Tickborne
Encephalities
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
TG 300 ATTACHMENT B
IMMUNIZATIONS
Immunizations for Peace Corps Volunteers
Indications and Administration
Vaccine
Encephalitis,
Japanese (JE)
Indications
All Volunteers serving
in endemic areas (see
text)
Primary Series
0.5ml IM days 0,28
Booster
If primary series >1yr
then 0.5 ml booster may
be given
JE-VC
Precautions / comments
Delayed hypersensitivity
may be seen up to 10 days
later
Local or mild systemic
reactions in 20%
Ixiaro
Imojev
Encephalitis,
Tick-Borne
(TBE)
High risk of exposure to

ticks in an endemic area
(see text)
IMMUNO
Hepatitis A
0.5 ml IM x 1
Every 5 years
0.5ml IM months 0, 1,
and 12
0.5ml IM every 3 years
Accelerated: 0.5 ml IM
days 0, 7, and 21
Egg anaphylaxis,
thimerosol anaphylaxis
Immuno (Austrian) vaccine
is effective and well
tolerated
All Volunteers
Hepatitis A vaccine
1.0ml IM months 0, 6
GLAXO-SMITH-KLINE (HAVRIX)
MERCK (VAQTA)
None after 2nd dose;

effective >25 years
Prior allergy to hepatitis A

vaccine, alum, 2phenoxyethanol
Occasional local or mild
systemic reactions
Immune globulin (IG)
5ml (0.06ml/kg) IM
Repeat every 4 months
IG use in Peace Corps is limited to

rapid protection for 1 month after
Hepatitis A vaccination in certain
individuals (see text) or for persons
allergic to Hepatitis A vaccine,
Mild local reaction

common
Prefer to complete
Preservice
1.0ml IM (deltoid):
months 0, 1, 6
GLAXO-
All Volunteers except:
SMITHKLINE
MERCK
PASTEUR
Serologic evidence of
immunity (see TG)
Accelerated: 1.0 ml IM
months 0, 1, and 2 with
a booster at 12 months
Hepatitis B
Prior allergy to immune

globulin; give more than 3
months before, or 14 days
after, MMR
None for standard

12 months for
accelerated dosing
Prior allergy to hepatitis B

vaccine
Occasional local or mild
systemic reactions
Also: if occupational
risk of blood exposure,
measure antibody level
1-6 months after series
Influenza
All Volunteers
0.5 ml IM annually
(Sept/Oct for Northern
Hemisphere)
repeat annually
Egg anaphylaxis, prior

vaccine-induced GuillainBarre.
Local reactions common,
occasional mild systemic
Page 1, July 2016
TG 300 ATTACHMENT B
Vaccine
Indications
Primary Series
All Volunteers except:

If never immunized and
Measlesborn in or after 1957:
Mumps-Rubella Age 50
(MMR)
Documented 2 doses of 0.5ml SC months 0,1
MMR
Serologic evidence of
immunity (see text).
Meningococcal
Meningitis
A, C, Y,
W-135
All Volunteers in
endemic or epidemic
areas.
0.5ml SC (1 dose)
Pneumococcal
Pneumonia
PPSV23
Dose given Pre-service

to cover:
0.5ml IM (1 dose)
PCV13
Age 65
Surgical or functional
asplenia.
At risk for infection or
complication.
Immunocompromised,
cochlear implant,
smoking, heart disease,
pulmonary disease
Give 0.5ml SC to all

Volunteers except those
meeting criteria listed.
no further boosters
necessary
Pregnancy,
immunosuppression,
neomycin anaphylaxis,
gelatin anaphylaxis, egg
anaphylaxis.
Fever 5-12 days later in
15%. rash in 5%;
arthralgias or arthritis some
women
Every 5 years
Pregnancy (consider
risk/benefit)
Local mild reactions seen
Not recommended
Pregnancy (consider
risk/benefit)
Local reactions common,
occasional mild systemic
0.5ml IM (1 dose)
All Volunteers: one dose

of IPV booster if serving
in an endemic area.
Polio
Rabies
(preexposure)
HDCV
PCEC
VERORAB
REQUIRED:
highly endemic areas
and/or inadequate access
to post-exposure series
HDCV
PCEC
0.5ml SC months 0, 1,
and 2 if prior
vaccination in doubt
0.5ml SC once as an
adult for countries
mentioned in TG
Anaphylaxis to neomycin,
streptomycin, polymyxin
well tolerated
HDCV/ PCEC: Every 3- Egg anaphylaxis for PCEC,

5 years
anaphylaxis or type II
reaction to prior vaccine
Verorab: no booster
Steroids and immunonecessary despite
OPTIONAL:
(or days 0, 7, 28)
supressives interfere with
package insert
developed countries
response
information (US DoS,
with adequate access to Verorab; 0.5 ml IM days 2016)
post-exposure series and 0, 7, 21 (or days 0, 8,
rabies immune globulin 28)
See text for postRabies

(postexposure) exposure
recommendations
RVA
Booster
Clean wound well with

soap and water
HDCV/ PCEC
Preferred: 1.0ml IM
only:
days 0, 7, 21
COMPLETED
PREEXPOSURE:
2 doses 1.0ml IM:
days 0, 3
As for pre-exposure vaccine
INCOMPLETE OR NO
PREEXPOSURE:
HRIG plus 4 doses IM:
days 0, 3, 7, 14
Page 2, July 2016
TG 300 ATTACHMENT B
Indications
Primary Series
Tetanusdiphtheria (Td)
All Volunteers must

have received Td or Tap
Pre-service to last
throughout their PC
service; dosing q 5 years
to cover unsanitary
wounds
Doses given at 0, 1, and

7-12 if prior vaccination
in doubt. Tdap can be
substituted for any one
of the three Td doses in
the series.
Dose given every 5

Prior severe hypersensitivity
years while in high-risk or neurologic reaction
areas
Local reactions common.
Use Td in adults (not DT or
tetanus toxoid alone)
0.5ml IM (one dose)
0.5ml IM every 2
years; optional for
PCVs completing
regular 27 month tour
Hypersensitivity to ViCPS
repeat every 5 years
Delay if experiencing GI
illness or if on antibiotics;
give 24 hrs before or after
mefloquine or Diamox
Tetanusdiphtheriapertussis (Tdap)
Booster
Vaccine
All Volunteers except in

low risk countries
Typhoid
ViCPS (Typhim Vi)
Ty21a (oral typhoid vaccine)
1 capsule with cool

liquid on days 0, 2, 4, 6
Mild local reactions seen
Infrequent nausea, abd.

cramps
ENSURE COLD CHAIN;
DO NOT FREEZE
Heat/phenol killed vaccine
Yellow Fever
0.5ml SC days 0, 30
All Volunteers in
0.5ml SC (one dose)
endemic areas, those
requiring vaccination
entry into country of
service, those volunteers
traveling to country
where vaccine required*
0.5ml SC every 3 years
Prior severe reaction to

heat/phenol killed vaccine
every 10 years
Pregnancy, immunosupression, egg anaphylaxis,

age <6 mo. or >60
<5% mild systemic reactions
STORE FROZEN- USE
WITHIN 1 HOUR
Precautions: Do not administer this vaccine if any of the listed conditions are present. Consult OMS to review the
risks and benefits, which may include vaccination after informing the Volunteer of the risks and benefits or transfer
or medical separation to avoid exposure to this disease.
*Countries where YF/ Official certificate vaccine required: Coming from US: Benin, Burkina Faso, Cameroon,
Ghana, Liberia, Mali, Rwanda, Sierra Leone, Togo; Coming from country with transmission risk: Botswana, Cape
Verde, Ethiopia, Gambia, Guinea, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Namibia, Senegal, South
Africa, Swaziland, Tanzania, Uganda, Zambia
Page 3, July 2016
TG 300 Attachment D
Peace Corps Immunization Roster

PCV/T Name
MMR
IPV
TD
Date:
Date:
Date:
Hep A
#1
Date:
Hep A
#2
Date:
Hep B
#1
Date:
Hep B
#2
Date:
Hep B
#3
Date:
Typhoid
Date:
PC-1562 (4/2014)
TG 300 ATTACHMENT E
Flu shots for staff
1. Presently the Peace Corps provides flu shots to all Volunteers and Washington staff but
not to overseas staff.
2. The Peace Corps has the legal authority to provide flu shots to both US and non-US
citizens and both direct-hire and PSC employees. Flu shots will be voluntary.
3. We propose a variety of options be made available to Posts and Posts be given the
discretion to choose one or more options.
4. OHS has informed State MED of Peace Corps intention to provide flu shots to host
country staff and State MED raised no objections. State MED has no overall policy for
flu shots for local staff. It is the decision of each US Embassy Medical Unit.
Options
1. PCMO gives flu shots to staff. The PCMO will order enough vaccine to cover the staff
members interested in having a flu shot as well as for the PCVs. (Note: the flu shot is
optional for staff but mandatory for PCVs). Therefore, most Posts will be covered by the
option of the PCMO then administering the vaccine. PCMOs will have liability under
local law for host country citizen employees, but the risk is minimal. The Peace Corps
has authority to indemnify PCMO for any damages and to pay attorney costs, but the
decision to do so is done after there is a claim. There may be some reluctance on part of
PCMOs as to increase liability and PCMOs will be permitted to opt out of administering
vaccine to staff at Post.
2. Reimbursement to private doctors in country to give flu shots. Posts set a fixed price and
determine if vaccine is available locally. Posts could contract directly with doctor;
reimburse employee; or reimburse doctor based on employees voucher. If the vaccine
is not available, Peace Corps will provide vaccine and syringes for administration to local
doctor if permitted by local law.
June 2016
320621 10/11/02 11:07 AM Page 1
WEBSITE: www.vaers.hhs.gov
E-MAIL: info@vaers.org
FAX: 1-877-721-0366
VACCINE ADVERSE EVENT REPORTING SYSTEM
For CDC/FDA Use Only
24 Hour Toll-Free Information 1-800-822-7967

P.O. Box 1100, Rockville, MD 20849-1100
PATIENT IDENTITY KEPT CONFIDENTIAL
Patient Name:
First
Last
M.I.
Address
State
City
Telephone no. (____) ______________________

1. State
Form completed by (Name):
Responsible
Physician
Facility Name/Address
Relation
Vaccine Provider
Patient/Parent
to Patient
Manufacturer
Other
Address (if different from patient or provider)
State
Zip
4. Patient age
mm
dd
yy
9. Patient recovered
YES
NO
5. Sex
M
6. Date form completed

F
mm
12. Relevant diagnostic tests/laboratory data
dd
yy
Check all appropriate:

Patient died
(date
mm
dd
yy
Life threatening illness
Required emergency room/doctor visit
Required hospitalization (________days)
Resulted in prolongation of hospitalization
Resulted in permanent disability
None of the above
10. Date of vaccination
UNKNOWN
Zip
Telephone no. (____) ______________________
8.
7. Describe adverse events(s) (symptoms, signs, time course) and treatment, if any
State
City
Telephone no. (____) ______________________

3. Date of birth
2. County where administered
Date Received
Vaccine administered by (Name):
City
Zip
VAERS Number
mm
dd
11. Adverse event onset
yy
mm
dd
yy
AM
AM
Time ____________ PM Time ____________ PM
13. Enter all vaccines given on date listed in no. 10

Vaccine (type)
No. Previous
Doses
Route/Site
Lot number
Manufacturer
a.
b.
c.
d.
14. Any other vaccinations within 4 weeks prior to the date listed in no. 10
Vaccine (type)
Manufacturer
Lot number
Date
given
No. Previous
doses
Route/Site
a.
b.
15. Vaccinated at:
Private doctor's office/hospital
Public health clinic/hospital
Military clinic/hospital
Other/unknown
18. Illness at time of vaccination (specify)

20. Have you reported
this adverse event
previously?
No
To doctor
16. Vaccine purchased with:

Private funds
Military funds
Other/unknown
Public funds
17. Other medications
19. Pre-existing physician-diagnosed allergies, birth defects, medical conditions (specify)
Only for children 5 and under
To health department
To manufacturer
21. Adverse event following prior vaccination (check all applicable, specify)
Onset
Type
Dose no.
Adverse
Age
Vaccine
in series
Event
22. Birth weight

__________ lb. _________ oz.
23. No. of brothers and sisters
Only for reports submitted by manufacturer/immunization project

24. Mfr./imm. proj. report no.
25. Date received by mfr./imm.proj.
26. 15 day report?
27. Report type
In patient
In brother
or sister
Yes
No
Initial
Follow-Up
Health care providers and manufacturers are required by law (42 USC 300aa-25) to report reactions to vaccines listed in the Table of Reportable Events Following Immunization.
Reports for reactions to other vaccines are voluntary except when required as a condition of immunization grant awards.
Form VAERS-1(FDA)
320621.qxd5
10/3/02
10:29 PM
Page 2
"Fold in thirds, tape & mail DO NOT STAPLE FORM"

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
OR APO/FPO
BUSINESS REPLY MAIL

FIRST-CLASS MAIL
PERMIT NO. 1895
ROCKVILLE, MD
POSTAGE WILL BE PAID BY ADDRESSEE
VAERS
P.O. Box 1100

Rockville MD 20849-1100
DIRECTIONS FOR COMPLETING FORM

(Additional pages may be attached if more space is needed.)
GENERAL
Use a separate form for each patient. Complete the form to the best of your abilities. Items 3, 4, 7, 8, 10, 11, and 13 are considered
essential and should be completed whenever possible. Parents/Guardians may need to consult the facility where the vaccine was
administered for some of the information (such as manufacturer, lot number or laboratory data.)
Refer to the Reportable Events Table (RET) for events mandated for reporting by law. Reporting for other serious events felt to be
related but not on the RET is encouraged.
Health care providers other than the vaccine administrator (VA) treating a patient for a suspected adverse event should notify the
VA and provide the information about the adverse event to allow the VA to complete the form to meet the VA's legal responsibility.
These data will be used to increase understanding of adverse events following vaccination and will become part of CDC Privacy
Act System 09-20-0136, "Epidemiologic Studies and Surveillance of Disease Problems". Information identifying the person who
received the vaccine or that person's legal representative will not be made available to the public, but may be available to the
vaccinee or legal representative.
Postage will be paid by addressee. Forms may be photocopied (must be front & back on same sheet).
SPECIFIC INSTRUCTIONS
Form Completed By: To be used by parents/guardians, vaccine manufacturers/distributors, vaccine administrators, and/or the person
completing the form on behalf of the patient or the health professional who administered the vaccine.
Item 7:
Describe the suspected adverse event. Such things as temperature, local and general signs and symptoms, time course,
duration of symptoms, diagnosis, treatment and recovery should be noted.
Item 9:
Check "YES" if the patient's health condition is the same as it was prior to the vaccine, "NO" if the patient has not returned
to the pre-vaccination state of health, or "UNKNOWN" if the patient's condition is not known.
Item 10: Give dates and times as specifically as you can remember. If you do not know the exact time, please
and 11: indicate "AM" or "PM" when possible if this information is known. If more than one adverse event, give the onset date and
time for the most serious event.
Item 12: Include "negative" or "normal" results of any relevant tests performed as well as abnormal findings.
Item 13: List ONLY those vaccines given on the day listed in Item 10.
Item 14: List any other vaccines that the patient received within 4 weeks prior to the date listed in Item 10.
Item 16: This section refers to how the person who gave the vaccine purchased it, not to the patient's insurance.
Item 17: List any prescription or non-prescription medications the patient was taking when the vaccine(s) was given.
Item 18: List any short term illnesses the patient had on the date the vaccine(s) was given (i.e., cold, flu, ear infection).
Item 19: List any pre-existing physician-diagnosed allergies, birth defects, medical conditions (including developmental and/or
neurologic disorders) for the patient.
Item 21: List any suspected adverse events the patient, or the patient's brothers or sisters, may have had to previous vaccinations.
If more than one brother or sister, or if the patient has reacted to more than one prior vaccine, use additional pages to
explain completely. For the onset age of a patient, provide the age in months if less than two years old.
Item 26: This space is for manufacturers' use only.
TG 300 ATTACHMENT G
Flu shots for staff

1. Presently the Peace Corps provides flu shots to all Volunteers and Washington staff but
not to overseas staff.
2. The Peace Corps has the legal authority to provide flu shots to both US and non-US
citizens and both direct-hire and PSC employees. Flu shots will be voluntary.
3. We propose a variety of options be made available to Posts and Posts be given the
discretion to choose one or more options.
4. OHS has informed State MED of Peace Corps intention to provide flu shots to host
country staff and State MED raised no objections. State MED has no overall policy for
flu shots for local staff. It is the decision of each US Embassy Medical Unit.
Options
1. PCMO gives flu shots to staff. The PCMO will order enough vaccine to cover the staff
members interested in having a flu shot as well as for the PCVs. (Note: the flu shot is
optional for staff but mandatory for PCVs) 66% of posts have PCMOs licensed in host
country. Therefore, most Posts will be covered by the option of the PCMO then
administering the vaccine. PCMOs will have liability under local law for host country
citizen employees, but the risk is minimal. The Peace Corps has authority to indemnify
PCMO for any damages and to pay attorney costs, but the decision to do so is done after
there is a claim. There may be some reluctance on part of PCMOs as to increase liability
and PCMOs will be permitted to opt out of administering vaccine to staff at Post.
2. Reimbursement to private doctors in country to give flu shots. Posts set a fixed price and
determine if vaccine is available locally. Posts could contract directly with doctor;
reimburse employee; or reimburse doctor based on employees voucher. If the vaccine
is not available, Peace Corps will provide vaccine and syringes for administration to local
doctor if permitted by local law.
April 2014
ATTACHMENT G: US Department of State-MED Approved and Non Approved Non FDA Licensed Vaccines
Approved:
Vaccine
Contents
Manufacturer
Act-HIB
HIB conjugate
Sanofi-Pasteur
Adacel
Tdap
Sanofi-Pasteur
Equivalent FDA approved product from

same company.
Avaxim
Hep A
Sanofi-Pasteur
Equivalent product from recognized

multinational company.
Avaxim Ped
Hep A
Sanofi-Pasteur MSD

Covaxis
Tdap
Sanofi-Pasteur MSD

same company.
Encepur
TBE
Novartis
No US equivalent; product from

recognized multinational company
Engerix-B
(Erwachsene)
Hep B
GSK

same company.
Hep B
Trivalent seasonal
influenza
TBE
LG life Sciences
JEV
Green Cross
Havrix
Hep A
GSK
Havrix Jr. or
Havrix 720 Kinder
Hep A
GSK
Gardasil
HPV quadrivalent
Sanofi-Pasteur MSD
Hexavac
DTaP/HepB/IPV/Hib
Sanofi-Pasteur
Hexaxim
DTaP/IPV/HepB/Hib
Sanofi-Pasteur
IMOJEV
Live attenuated JE vaccine
Sanofi-Pasteur
Imovax d.t.
Imovax Polio
Inactivated Influenza
Vaccine (Split Virion)
BP
Td
IPV
Sanofi-Pasteur
Sanofi-Pasteur
Trivalent seasonal
influenza
Sanofi-Pasteur MSD

same company.
Infanrix
DTaP
GSK

same company.
Infanrix Hexa
DTaP/HepB/IPV/Hib
GSK
GSK/Australia
Equivalent to approved components from

recognized multinational company.
Infanrix-IPV
DTaP/IPV
GSK
Euvax B
Afluria
FSME-Immune
Green Cross Japanese
Encepahalitis
CSL Biotherapies
Baxter
Comments
same company.
WHO prequalified.
FDA approved but limited to ages 9+
years
Best alternative; no US vaccine.
Best alternative; for countries where no
US vaccine is available.
same company.
same company.
same company.
recognized multinational company
(Pentaxim plus Hep B)
WHO prequalified.
WHO prequalified.
recognized multinational company and

WHO prequalified.
Infanrix-IPV+Hib
DTaP/IPV/Hib
GSK
Influvac
Trivalent seasonal
influenza
Abbott
IPV Merioux
Polio
Sanofi-Pasteur

same company.
JEEV
JEV
Biological Evans,
Ltd
Equivalent to FDA approved product

(Ixiaro), licensed by Intercell.
JESPECT
JEV
Intercell

same company.
Mencevax ACW135Y
Mencevax ACWY
Meningitis Polysaccharide
GSK

multinational company, components of
same strength FDA approved
Merieux (MIRV)
Rabies, inactivated
Sanofi-Pasteur

same company.
M-M-R vaxPro
MMR
Sanofi Pasteur MSD

same strength FDA approved
Mutagrip
Trivalent seasonal
influenza
Sanofi-Pasteur

same company.
Nimenrix
Meningococcal TT
conjugate A, C, Y, W-135
GSK

Pentavac
DTaP/IPV/HIB
Sanofi-Pasteur
Equivalent to Pentacel from same

company with FDA approval.
Pentaxim
DTaP/IPV/HIB
Sanofi-Pasteur
Poliorix
IPV
GSK
Pneumo 23
PPSV-23
Sanofi-Pasteur
Prevenar 13
PCV13
Wyeth, Pfizer
Priorix
MMR
GSK
Priorix-Tetra
MMRV
GSK
Quadracel
DTaP/IPV
Sanofi-Pasteur
Rabigam IM
RIG
National
Bioproducts Institute
Rabipor
Rabies
Chiron Behring
Vaccines Pvt. Ltd
Equivalent to Pentacel from same

company with FDA approval.
WHO prequalified.
same strength FDA approved.
same company.
WHO prequalified.
Equivalent product (Kinrix) from
Equivalent product from local company
meeting international standards for
handling blood products and storage of
supply.
WHO prequalified.
Rabipur
Rouvax
Rabies
Measles
Chiron/Germany
Sanofi-Pasteur
WHO prequalified.
WHO prequalified.
same strength FDA approved (Adacel)
WHO prequalified.
same company. (Td and IPOL).
Repevax
dTap/IPV
Sanofi-Pasteur
Stamaril
YF
Sanofi-Pasteur
Td Polio Adsorbed
Td/IPV
Sanofi-Pasteur
Tetavax
TT
Sanofi-Pasteur
Tetravac
DTaP/IPV
Sanofi-Pasteur
Tetraxim
DTaP/IPV
Sanofi-Pasteur
Trimovax
MMR
Sanofi-Pasteur
WHO prequalified.
TwinRix
Hep A and B
GSK

same company.
Typhim Vi
Typhoid
Sanofi-Pasteur

same company.
Varilrix
Varicella
GSK

Varivax
Varicella
Sanofi-Pasteur MSD

same company.
Vaxigrip
TVI seasonal
Sanofi-Pasteur
Verorab
Rabies
Sanofi-Pasteur
CD.JEVAX
JEV
Chengdu Institute
Kuo Kwang
JEV
Adimmune
Okavax
Varicella
BIKEN
Denied; single dose preparation with

75% of US antigen.
Prevenar 7
PCV7
Wyeth
Formulation no longer in use.
Rabivax
Rabies
SII/India
Synflorix
PCV10
GSK
Tresivac
MMR
SII/India

same company. (Note US approval for
ages 4-6 only)
multinational company; components of

same company.
WHO prequalified; dose is 0.5 mL
Non Approved:
Safer options available. Monitoring of
safety and efficacy are not transparent.
Safer FDA approved options available;
different primary series schedule from
approved mouse brain products.
Not WHO prequalified; quality data

unknown.
Not equivalent to Prevnar 13.
Measles and Mumps viruses vary from US
MMR; dose of mumps lower than US
product; age indication restricted to children.
Peace Corps
INITIAL CLINICAL INTAKE INTERVIEW PROCESS
1.
PURPOSE
To provide guidance on initial clinical intake interview activities for Peace Corps Trainees and
Peace Corps Response Volunteers. Note: For purposes of this TG, Trainee can mean Trainee or
Response Volunteer.
2.
BACKGROUND
The purpose of the initial intake interview is for the PCMO to:
Meet with the Trainee one-on-one
Review information from the Trainee Clinical Intake Questionnaire,
Provide the Trainee with a hard copy of the Continuous Care Document (CCD) to validate
information in the Trainees medical record
Update information in the Trainees medical record
Identify any non-disclosures
Briefly assess current health status of the Trainee
Determine required immunizations while in-country
Determine and dispense malaria prophylaxis (if applicable)
Discuss treatment plans for chronic and/or accommodated health issues
Obtain Volunteer Email Authorization form (TG 210 , Attachment G)
Obtain Volunteer Immunization Consent form (TG 300, Attachment D)
Obtain Volunteer Consent to Disclose to Family/Friends form (TG 301, Attachment B)
Reinforce health promotion and disease prevention activities
The initial clinical intake interview is critical in establishing clinician-patient rapport and
validating the basic clinical care needs of the trainee for his or her service. All Trainees must
undergo an initial clinical intake interview performed by the PCMO within 72 hours upon arrival
to country. The Trainee Clinical Intake Questionnaire (Attachment A) contains two sets of
questions: provider questions that are needed immediately for the PCMO to assume care of the
Trainee and screening questions that are needed for the PCMO to have a more holistic
understanding of the Trainees health, lifestyle, and prevention areas.
Time on the Pre-Service Training (PST) schedule must be provided to the PCMO and Trainees in
order to complete the Trainee Clinical Intake Questionnaire (Attachment A). Time may vary for
this interview depending on the health needs of the Trainee. A minimum of twenty (20) minutes
should be allotted per interview. Depending on the outcome of the initial interview and health
care needs of the Trainee, subsequent discussion(s) may be needed.
December 2015
As outlined by their scope of practice and defined duties, medical assistants may assist the
PCMO in the intake interview process. Please contact OHS if there is a question regarding
PCMEDICS intake duties for medical assistants.
3. CLINICAL INTAKE INTERVIEW PREPARATION
Steps:
1. Print out each Trainees individual Continuous Care Document (CCD) and take to PST site
where clinical intake interviews are taking place.
2. Sync the laptop so that you have a current instance of PCMEDICS to take to the PST site.
3. Ensure that you have the equipment and supplies for the Clinical Intake Interview:
a. Laptop with PCMEDICS
b. Electrical cord and plug
c. Extension cord
d. Handheld scanner (if applicable)
e. Paper copies of blank Clinical Intake Questionnaires (Attachment A)
f. Paper copy of each Trainees CCD
g. General medications and supplies
h. Immunization consent form
i. Email consent form (TG 210 G)
4. COMPONENTS OF THE INITIAL INTAKE INTERVIEW
There are four basic components to an intake interview: Health Record Information and
Validation, Health Assessment, Healthcare Treatment Planning, and Documentation.
Health Record Information and Validation
Steps:
1. Provide each Trainee with a hard copy of the CCD and ask them to review prior to the
interview.
2. Provide the Trainee the Clinical Intake Questionnaire (Attachment A) in paper form for
the Trainee to complete (both provider and screening questions) prior to the intake
interview.
3. Meet with each Trainee individually to discuss the information on Trainee Clinical Intake
Questionnaire.
4. Review with the Trainee his or her electronic medical record (CCD) to ensure data is
correct and to socialize the Trainee to his/her electronic medical record. The PCMO
edits/updates data directly into PCMEDICS based on the Trainee Clinical Intake
Questionnaire and discussion.
5. Discuss any discovered non-disclosed information with the Trainee. If non-disclosure
suspected, PCMO to follow TG 190, Medical Non-Disclosure.
Health Assessment
Steps:
Based on general appearance and basic questioning (e.g. How are you? Any current
health issues that need medical attention?), the PCMO should assess the current health
December 2015
status of the Trainee. Baseline vital signs and weight should be obtained. No
examination is required at this time, but should be at the discretion of the PCMO
according to information provided by the Trainee on his or her current health status.
Healthcare Treatment Planning
Steps:
1. Determine immunizations required for service (TG 300, Immunization) by reviewing any
immunization documentation in the medical record as well as presented by the Trainee
(e.g. WHO card, child immunization record, etc.)
2. Obtain Vaccine Consent Form signed by Trainee (TG 300, Attachment C)
3. Discuss and document malaria prophylaxis plan if applicable (TG 840, Prevention of
Malaria) and obtain consent form signed by Trainee
4. Discuss accommodation treatment/care plans outlined by Pre-Service
5. Discuss communication with the PCMO (Volunteer Email Authorization form) and obtain
signed form indicating Trainees preference (TG 210 Attachment G)
6. Discuss which information the PCV would like shared and with whom in the event of
illness and obtain signed form (TG 301 Attachment B)
7. Provide any preventative education pertinent at this time
Documentation of the Interview
Steps:
At the end of the Clinical Intake interview, the PCMO should:
1. Complete a Patient Encounter Form and e-Sign in PCMEDICS within 72 hours of the
intake interview.
2. Scan the Trainees Clinical Intake Questionnaire and upload to document folder PST
Intake Documents in PCMEDICS.
3. Scan all Consent and Authorization Forms into PCMEDICS in document folder Volunteer
Consents/Waivers.
4. If unable to complete an electronic PEF at PST, the PCMO will need to capture the data
on a blank PEF (TG 210, Health Records, Attachment E) at PST and then enter the PEF
discrete data once the PCMO has access to PCMEDICS or attach to paper record.
Note: The information may be entered directly into PCMEDICS at PST if connectivity exists or in
offline mode to be syncd once back at the medical office.
December 2015
Peace Corps
VOLUNTEER CONCERNS
1.
PURPOSE
To provide a means for Volunteers to report concerns related to health care.
2.
BACKGROUND
At Peace Corps we believe in creating a culture that embraces quality, Volunteer

safety, and service satisfaction. In order to ensure that we continue to provide
quality care, we offer the Volunteer the opportunity to express concerns if the
Volunteer is unsatisfied with the care received.
3.
PROCESS
The Quality Improvement department receives and processes Volunteer concerns

regarding Peace Corps health care delivery systems; including but not limited to
Peace Corps Medical Officers (PCMOs), consultants, contracted facilities and
Volunteer Support.
Volunteers are encouraged to follow the process outlined below to express a
concern regarding their health care:
1. If comfortable, a Volunteer can inform the PCMO if they are dissatisfied with the
care they have received or
2. Follow the Post policy for reporting concerns or
3. File an email concern with the Quality Improvement (QI) Department at
headquarters QualityNurse@peacecorps.gov
In the email the Volunteer must include:
Volunteers name
Volunteers location
PCMO (or other health care provider) involved
Detailed description of the health care related concern
The Volunteer can expect a response from headquarters within five (5) business
days.
A Volunteers medically confidential information will be shared only with Peace
Corps staff who have a specific need to know to address the situation appropriately.
To the extent possible consistent with appropriate handling of the Volunteers
concern, the Volunteers identity will be kept confidential.
The Volunteer should be informed that email is not a secure method of
communication. If the Volunteer chooses to communicate via email, Peace Corps
will ask the Volunteer to sign a waiver acknowledging the risk of communicating
via email (Attachment A).
______________________________________________________________________________
January 2016
Page 1 of 2
Peace Corps staff may not retaliate against a Volunteer for reporting a concern. This
forum (email) is open to Volunteers only.
4.
POST REPONSIBILITIES
All Posts are required to post the name, title, location, and telephone number of the
individual at Post who is responsible for receiving concerns and conducting
investigations, as well as the headquarters quality improvement email address and
instructions on how to file a concern.
5.
HEADQUARTERS RESPONSIBILITIES
Maintain the email box
Respond timely and appropriately to the Volunteers concerns
Keep post involved in the problem solving process
Provide post with announcements to post in offices (contact QI unit for posters)
Trend Volunteer concerns
______________________________________________________________________________
January 2016
Page 2 of 2
TG 302 Attachment A
Peace Corps
CONSENT/AUTHORIZATION FORM
REMINDER: THIS IS COMPLETELY VOLUNTARY

I, ____________________________, hereby authorize the Peace Corps Office of
Medical Services to communicate with me by electronic mail at the email address listed
below. I understand that protected health information, which may include personally
identifiable and medically sensitive information about me, may be included in such
communications.
This disclosure is at my request. I understand that there is some risk of inadvertent
disclosure to unauthorized persons during transmission. I understand that the information
disclosed pursuant to this consent is subject to re-disclosure by the recipient(s), which
may result in the loss of Privacy Act or Health Insurance Portability and Accountability
Act (HIPAA) protections. This authorization is effective for as long as I remain in Peace
Corps service. I understand that I may also revoke this authorization in writing at any
time.
Current e-mail address to be used for receipt of medically sensitive information:
Signature (Full Name)
Date
Full Name Printed
Date of birth
1111 20th Street, NW.
Washington, D.C. 20526
Peace Corps
HEALTH CARE CONSULTANT ON-LINE SATISFACTION SURVEY
1.
PURPOSE
To provide an avenue through which Volunteers and trainees (together,
Volunteers) can give non-urgent feedback to Peace Corps Medical Officers
(PCMOs) or the Office of Health Services (OHS) regarding the health care
provided to them.
If a Volunteer has an urgent or emergent concern related to quality of care that he or
she thinks is not being addressed appropriately by the PCMO, the Volunteer should
access Headquarters staff through the Medical Duty Officer.
2.
BACKGROUND
Peace Corps intent is to promote a medical culture that embraces Volunteer safety,
quality health care, and service satisfaction. As part of that effort, Volunteers are
offered the opportunity to provide input on health services received from outside
consultants and contracted facilities.
Aggregate data obtained from the survey will assist posts and OHS in assessing the
quality of care given by the health providers used by Volunteers. Peace Corps staff
may not retaliate against any Volunteer in relation to any feedback given.
3.
VOLUNTEERS OPTIONS TO PROVIDE FEEDBACK IN-COUNTRY

Volunteers are encouraged to use one or more of the options listed below to provide
the PCMO feedback regarding health care received in-country:
A. For input on outside providers, complete a Health Care Consultant Satisfaction
Survey available on-line through Survey Monkey at this website:
https://www.surveymonkey.com/s/surveyonhealthproviders
B. For input on any provider, discuss with the PCMO directly about the care
received; and/or
C. For input on any provider, file an email concern with the headquarters Quality
Improvement (QI) department at QualityNurse@peacecorps.gov (Refer to TG
302).
4.
VOLUNTEERS OPTIONS TO PROVIDE FEEDBACK WHILE ON

MEDEVAC
Volunteers are encouraged to use one or more of the options listed below to provide
OHS clinical staff and/or Regional Medical Officer (RMO) feedback regarding
health care received while on medevac:
______________________________________________________________________________
December 2012
Page 1 of 3
A. For input on outside providers, complete a Health Care Consultant

Satisfaction Survey available online through Survey Monkey at website:
https://www.surveymonkey.com/s/surveyonhealthproviders
B. For input on any provider, discuss with your Volunteer Support International
Health Coordinator or RMO directly about the care received, and/or
C. For input on any provider, file an email concern with the headquarters Quality
Improvement (QI) department at QualityNurse@peacecorps.gov (Refer to TG
302)
5.
POST AND MEDEVAC HUB RESPONSIBILITIES

All Posts and medevac hubs are required to:
Display in the posts PC medical office instructions on how Volunteers may

access the online Health Care Consultant Satisfaction Survey (Attachment
A).
Provide instructions in the regional medevac guide on how to access the
Survey online.
Participate in a post internal Quality Improvement program using the
Surveys as a source of information
o Consult with the Quality Improvement Unit to obtain post-specific,
aggregated Survey feedback to identify trends regarding Volunteer
satisfaction with health care providers.
o Review, organize, and analyze Survey information what will allow
you to document trends and actions taken in response to the Survey
information. This data can be used for yearly audit purposes by the
Office of Inspector General, OHS, and/or the Country Director.
o Consult with the Quality Improvement Unit, if necessary, on
questions or concerns on how to address or respond to feedback
received.
6.
OFFICE OF HEALTH SERVICES RESPONSIBILITIES

OHS is required to:
Make the Health Care Consultant Satisfaction Survey easily available in

electronic format to Volunteers while on medevac in Washington D.C. or at
Home of Record (HOR).
______________________________________________________________________________
December 2012
Page 2 of 3
o Display in the OHS HQ office instructions on how Volunteers may

access the online Health Care Consultant Satisfaction Survey
(Attachment A).
o Provide instructions on how to access the Survey online in the
Medevac Guide to Washington, D.C. and Medevac Guide to HOR.
Use the Survey as a source of information for the quality improvement

program:
o Monitor the Survey website routinely and identify trends regarding
Volunteer satisfaction with health care providers and consultants
o Carefully review circumstances in which Surveys rate providers in
the Fair (2) or Poor (1) categories.
o Document what actions were taken, when, and by whom in response
to Survey information.
o Maintain a Survey database to provide aggregated information to
posts and for yearly audit purposes by the OHS Quality
Improvement Unit and/or the Office of Inspector General.
______________________________________________________________________________
December 2012
Page 3 of 3
HEALTH CARE
CONSULTANT
SATISFACTION SURVEY
How was your recent Visit to a

Health Care Provider?
Question
Survey
Good or Bad, We want to know.
Help Peace Corps improve your

In-country health care
ANONYMOUS. NO RETALIATION FOR PROVIDING YOUR FEEDBACK
https://www. surveymonkey.com
/s/surveyonhealthproviders
Thank you for assisting us in assessing and monitoring our clinical care program.
Thank you for assisting us in assessing and monitoring our

careAprogra
TG clinical
304 Attachment
Peace Corps
PCMO OVERSIGHT OF THE HOSPITALIZED VOLUNTEER
1.
PURPOSE
To provide information regarding Peace Corps Medical Officer (PCMO) oversight
responsibilities of a hospitalized Volunteer.
2.
BACKGROUND
It has always been the responsibility of PCMOs to provide oversight of the
hospitalized Volunteer regardless of severity of illness and/or disease.
3.
PCMO OVERSIGHT RESPONSIBILITIES/CORE EXPECTATIONS
A PCMO will oversee the care provided to the hospitalized PCV.

o Unless it is deemed that the PCVs problem is minor, the PCVs condition
is stable and the PCVs hospitalization will be less than 72 hours, the
PCMO should make every effort to go to the hospital. These criteria do
not preclude the PCMO from going to the hospital even if the PCV is felt
to have a minor problem.
o If the PCV is considered to have a significant medical problem, the PCMO
should immediately go to the facility unless going to the hospital will
cause a delay in activating an emergency medical evacuation.
o All medically unstable PCVs will be examined by a PCMO as soon as
possible, which in some circumstances may mean travelling to the PCV by
air.
o PCMOs must have at least daily contact with the preapproved or other
designated provider at a hospital where a PCV has been hospitalized. The
frequency of contacts with the providers is dependent on the PCVs
condition with the expectation that the PCMO literally is up to the
minute on the PCVs status.
All hospitalized Volunteers must be accompanied by a member of the Peace

Corps staff (PCMO, CD, AO, etc.) as soon as is practical. The staff person must
be able to serve as advocate and translator for the PCV.
Volunteers can accompany another Volunteer in an emergency; however, the
Volunteer must be replaced by a Peace Corps staff member as soon as feasible.
______________________________________________________________________________
June 2016
Page 1 of 2
If the PCV is able to communicate, the PCMO must make contact with the PCV
at least daily.
Documentation of any contact with the PCV and/or providers caring for the PCV
must be noted in the health record (refer to TG 210).
Any post-hospitalization follow-up must be documented in the health record.
The PCMO will notify the Country Director when any significant situations, such
as changes in the PCVs condition or need to medevac, arise.
______________________________________________________________________________
June 2016
Page 2 of 2
Peace Corps
IN-COUNTRY HEALTH/MEDICAL AND SAFETY TRAINING
1. PURPOSE
To provide Peace Corps Medical Officers (PCMOs) and Peace Corps staff with guidance on
the health and safety training of Volunteers.
2. ELEMENTS OF HEALTH TRAINING

Comprehensive health training is a major part of the Volunteer health support program in
country. In addition to being one of the main components of Pre-Service Training (PST),
health training is continued and reinforced by the PCMO and staff throughout the
Volunteers tour.
The agencys approach to training mandates that training be organized around achievement
of Terminal Learning Objectives (TLOs). The TLOs describe the minimum content a trainee
must achieve during PST; posts can always choose to include additional post-specific
requirements and content. It is recommended for posts to use the Global Core medical
(curriculum) sessions to meet the TLOs.
The Global Core Medical Pre-Service Training Curriculum encompasses efforts of PC
Medical Officers (PCMOs), Office of Health Services (OHS) and Overseas Program and
Training Support (OPATS) staff to standardize the training and to fulfill the agencys
commitment to comprehensive education that prepares trainees for successful service.
PCMO INVOLVEMENT IN HEALTH TRAINING
Pre-Service Training (PST)
Performed overseas in country of service or in a third

country before Trainees swear in as Volunteers. The
training approach of achieving Terminal Learning
Objectives puts an emphasis on quality over quantity. For
logistical purposes, approximately 22 hours of health
training are recommended.
Resources: Global Core PST Medical Curriculum (see
sections 4 and 5 in this technical guideline)
In-Service Training (IST)
Usually takes place 3 to 6 months after PST.

Reinforcement of basic health and safety information and
introduction of advanced topics
Mid-Service Health Evaluation
Usually takes place 12 months after PST. Required health

maintenance evaluation of each Volunteer, often
conducted in association with IST or in an All-Volunteer
Conference
March 2015
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TG 310
Health & Safety Training
All Volunteer Conference
Optional annual meeting of all Volunteers, irrespective of

training group. Provides opportunity for reinforcement of
basic health and safety education and introduction of
advanced topics
Close of Service (COS)

Conference
Informs Volunteers about their post-service health

benefits, malaria prophylaxis, and other health care
needs. Reference: Technical Guideline (TG) 330 PostService Benefits
The health training program provides health education and prevention concepts and materials
to Trainees as they enter the overseas environment and supports, reinforces, and expands on
their skills at every opportunity throughout Volunteer service. At close of service (COS), the
program ensures that Volunteers are informed of their rights and responsibilities with respect
to post-service benefits, continuing health maintenance and health care.
The PCMOs must remind the PC staff, Peace Corps Trainees, and Peace Corps Volunteers
that V/Ts are not authorized to participate in direct health care activities unless they are
participants in the Global Health Services Partnership (GHSP) and authorized by the Country
Director. These activities include, but are not limited to, participating in immunization
programs, attending or otherwise assisting with childbirths, performing phlebotomy, insertion
of intravenous catheters, and other activities that may place them at risk for exposure to
blood or body fluids.
3. SAFETY TRAINING
The Office of Volunteer Safety and Security (SS) in Washington provides leadership and
guidance that supports Country Directors (CDs), overseas staff and Volunteers in all aspects
of safety and security.
Comprehensive safety training is a component of in-country Volunteer support and is the
responsibility of all Peace Corps staff. Safety training is delivered by Office of Safety and
Security. PCMOs are expected to collaborate with Office of Safety and Security
representatives and other PC post units and their staff to provide safety training during PreService Health Training (PST) and throughout the Volunteers service.
The safety training program is designed to prepare Volunteers for safe, healthy, and
productive service. Based on the unique circumstances under which Volunteers live and
work, the Agency has established the policy that:
Each post must provide Volunteers/Trainees (V/Ts) with a program of ongoing safety and
security training within the framework established by the Office of Safety and Security. The
training will be designed to increase V/Ts awareness of their in-country environment, build
their capacity to cope effectively with the many challenges they will face, and provide the
tools to adopt a safe and appropriate lifestyle. The training must promote a realistic
understanding of the possibility of accident, crime, disaster, injury, psychological trauma,
and loss of property during service. It must help V/Ts recognize factors that contribute to
March 2015
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TG 310
those risks and encourage compliance with Peace Corps policy. The training must be
designed to instill attitudes consistent with adopting a culturally appropriate lifestyle and
practicing measures expected to reduce risk (Peace Corps Manual Section (MS) 270, 5.0).
4. PRE-SERVICE TRAINING PREPARATION AND PLANNING

Preparation for a PST or other health training is a complex task requiring considerable
advanced planning.
Posts must take an integrated approach to Global Core that includes medical, safety and
security, programming and training staff in order to provide training that supports the
achievement of the TLOs.
Peace Corps Office of Health Services website provides all necessary information, materials,
forms, instructions and links to sessions. The website also offers additional recourses to how
to train PCV/Ts.
The PCMO Handbook can also assist with PST planning. It is available on the Peace Corps
Office of Health Services Trainings website.
A summary Pre-Service Planning Checklist is included in ATTACHMENT A.
5. TRAINING MATERIALS
The Volunteer Health System is responsible for providing consistent and accurate health
education to all Volunteers using prevention strategies based on the best available
information and Volunteer needs. The Office of Health Services (OHS) in collaboration with
the agencys other offices (e.g. Overseas Program and Training Support Office) establishes
training standards for health education (see section 2 above) and provides training materials
for use by in-country health and safety training programs. These materials are available on
the Peace Corps Office of Health Services Trainings website.
Health Training/Sessions
Health/Medical Pre-Service Training (PST) Curriculum is a teaching resource developed by
OHS for use by PCMOs in providing comprehensive health and wellbeing training at PST.
It is recommended for posts to use the new Global Core medical (curriculum) PST sessions
to meet the TLOs. The TLOs are stated on the cover page of each session plan. The session
objectives are designed to facilitate the achievement of the TLOs. The goal of each session
includes meeting the objectives and focusing on competency.
The resource contains eleven (11) Medical Global Core TLOs translated into fourteen (14)
medical sessions. Incorporation of the TLOs into PST is mandatory to the extent applicable
to each post.
The topics are as follows:
Alcohol
March 2015
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TG 310
Common Health Problems
Diarrhea
Domestic and Intimate Partner Violence
Emergencies
Food and Water Preparation
HIV and AIDS
Malaria
Mental Health Adjustment
Mental Health Stress
Nutrition
Peace Corps Policies and Procedures
Sexual Health and STIs
Urgent Common Issues
In addition or as part of the listed sessions, PCMOs should include the following countryspecific health topics in training:
Orientation to in-country care, e.g., accessing the health unit, contacting the PCMO, incountry medical facilities, and emergency preparedness;
Immunization program overview
Endemic disease overview
Environmental health overview
Use of the Volunteer health kits
PCMOs may develop and use pre- and post-tests and training evaluations to assess and
improve the effectiveness of the training. The Personal Health Plan is an assessment tool.
The sessions include the recommended time frame to complete the material and optimize
Volunteers success. Posts are, however, at liberty to adapt the training to meet the objectives
in a manner that best fits posts context. Consequently, posts, and medical units in particular,
may adjust the amount of time; and have control of sequence and approach of topics as well
as choices of available training resources such as PC/Washington, post-developed session
plans or other methods of learning.
Personal Health Plan
Volunteers must assume considerable responsibility for their health during Peace Corps
service while working as partners with PCMOs. This Personal Health Plan allows trainers
and trainees to work towards reaching that goal.
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TG 310
The Personal Health Plan is a platform for trainees to demonstrate a synthesis of their
learning and to create personal strategies of how to manage their health and wellbeing in
service. The complete Personal Health document becomes part of the Volunteers medical
records and a tool for discussion when a Volunteer needs/seeks support. It can be referenced
at in-service trainings and during medical appointments.
Posts are responsible for assessing the trainees achievement of the TLOs using the Trainee
Assessment Portfolio (TAP). Medical/health content is evaluated through the development of
the Personal Health Plan (a component of the TAP). The plan is an integral part of the health
training process to ensure that Volunteers take responsibility for their health and well-being.
Each Volunteer must submit a completed plan by the end of PST which a PCMO will review
and subsequently provide feedback shortly after but no later than 45 days upon conclusion of
PST (Health Plan Instructions provide details as on how to accomplish both).
Submission of the Personal Health Plan to the PCMO is required prior to swearing in.
PCMOs must ensure scheduling of sufficient work time to support the development of the
Personal Health Plan. A PCMO will need to review each Volunteers Health Plan
individually and provide complete and timely feedback to trainees/Volunteers in a caring and
coaching manner to provide ample opportunities for achieving mastery of all TLOs. The
completed Personal Health Plan must be signed by the Volunteer and the PCMO.
The Volunteers Personal Health Plan is a living document and should be revaluated during
IST and utilized during medical encounters for updates and adjustments. E.g. the PCMO can
take a copy of the plan and update when performing site visits.
Health Handbook
The PCMO is responsible for updating a country-specific Volunteer health handbook. This
handbook should be distributed to all Volunteers at PST. A basic Volunteer health handbook
contains four elements:
Overview of Peace Corps health policies and any country-specific Volunteer health
support program policies;
Prevention and health maintenance strategies for Volunteers;
General health reference information on common illnesses and health conditions;
Country-specific information and materials such as medical emergency procedures,

approved local health providers, site evacuation plans, etc.
Information developed by OHS, including TGs and their attachments, may be used in
revising and updating the Volunteer Health Handbook at posts.
March 2015
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TG 310 ATTACHMENT A
PRE-SERVICE TRAINING CHECK LIST

*Refer also to The Peace Corps Post: A Handbook for New Medical Officers.
Training Dates:
Training Site:
Training Director:
Contact Info:
1.
PST SUPPLIES (3 month before PST)

Order immunization supplies, e.g., vaccines, needles, syringes, sharps
containers, etc.
Order supplemental items for Volunteer Health Kits, e.g. thermometers, MIF kits, antibiotics,
etc.
Order country-specific supplies, e.g., water filters, smoke alarms, CO2 detectors, bicycle
helmets.
2. HEALTH HANDBOOKS AND VOLUNTEER RESOURCES (3 months before PST)

Update the country-specific Welcome Book if indicated.
Update and/or edit country-specific Volunteer Health Handbook
3. PST SCHEDULE (1-2 months before PST)

Set up a meeting with the Program and Training Director to plan health training (content/ health
topics, sessions set up) and to set up schedule (tentative dates and times).
4. LOGISTICS (1 month before PST)

Prepare a medical kit for the training site.
Set up a system for handling trainees medication and supply requests.
If needed, locate local health care facility or health care provider.
Determine referral and payment process.
Set up a system for managing ill trainees.
Set up a system for trainees to visit the health unit or see the PCMO privately at PST.
Determine appropriate site for giving immunizations and conducting intake interviews.
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TG 310 Attachment A
5. HEALTH INSPECTIONS AND TRAINING (1 month before PST)

Inspect the training site for health hazards. Report recommendations to the Program and
Training Director and the Country Director.
Check water source at training site to ensure potability or determine method for supplying safe
water.
Check availability of electricity at training site for PP sessions and refrigerator for possible
vaccine storage.
Educate kitchen staff on proper food hygiene, water treatment, and diet. Perform stool testing
on kitchen staff if appropriate.
Educate host families on proper food hygiene, water treatment, and diet. Visit host family
homes as time allows.
Provide host family with training on care of a sick trainee. Medical kits to be only used by
trainees; PCMO notification (give written information in host language if indicated).
Train Language and Cross-Cultural Facilitators (LCF) on care of a sick trainee, when to
contact PCMO and how to deal with emergencies.
6. HEALTH SESSIONS AND PCMO INTERVIEWS (1 month before PST)

Use Global Core PST Medical Curriculum to prepare medical sessions. Collaborate and
coordinate with the PT staff to organize the training to meet TLOs.
As needed, schedule PC staff and/or current volunteers required to assist during PST activities.
Prepare a health plan form for trainees to work on their Personal Health Plan during PST.
Prepare training materials, e.g., make copies, prepare flip charts and schedule guest speakers
as needed.
Prepare PST Medical Intake form.
Review charts and make lists of PMH, follow-up required, medications, allergies etc.
Set up an intake interview schedule to include tentative dates and times of interviews.
7. IMMUNIZATION PROGRAM (1 month before PST)

Review Technical Guideline (TG) 300 Immunization, and determine additional staffing needs.
Make copies of, PC-1634 Vaccine Consent Form (TG 300, Attachment C).
Make copies of, PC-1773 Immunization Record (TG 300, Attachment E).
Review vaccine records/prepare an Immunization roster (TG 300, Attachment D).
Set up a vaccination schedule to include tentative dates, times, and immunizations
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TG 310 Attachment A
Prepare Anaphylaxis Kit (TG 615) to take to immunization site.

Prepare immunization supplies for immunization site, e.g., vaccine, needles, syringes,
sharps disposal container, alcohol pads, gauze pads, cotton balls, Hand sanitizer, BandAids, Tylenol, cooler and ice packs, Peace Corps forms, etc.
Prepare Mass Immunization Inventory Rosters (MS 734, TG 240 Attachment I).
8. COORDINATION
Make list of accommodations to share with Country Director.
Make list of homestay restrictions for Training Director.
Page 3
Peace Corps
INTERIM HEALTH EVALUATIONS
1. PURPOSE
To provide guidance on Interim Health Evaluations for Peace Corps Volunteers.
2. BACKGROUND
All Volunteers should be seen at least one time 12 to 18 months after entry on duty. The
interim health evaluation can be performed concurrently with a medical visit for an acute
problem or separately with a scheduled visit.
The purpose of the interim health evaluation is to:
Evaluate and document the status of known chronic conditions, unresolved conditions,
and current medical problems including compliance and tolerance of prescribed
treatments by inviting the Volunteer to review the PCMEDICS Summary Page and
confirm/update: Allergies, Medications, Problems
Screen for asymptomatic health conditions, if indicated
Reinforce health promotion and disease prevention activities
Identify significant health risks or disease exposures
Peace Corps Medical Officers (PCMOs) document the interim health evaluation on the
electronic Peace Corps Interim Health Evaluation form in PCMEDICS, based on a detailed
history provided by the Volunteer and history-guided examination.
3. COMPONENTS OF THE INTERIM HEALTH EVALUATION
COMPONENTS OF THE INTERIM HEALTH EVALUATION: A SUMMARY

Update the health history (see 3.1).
All Volunteers
Weight, Vital Signs and a history-guided physical examination

(see 3.2).
All Volunteers
Pelvic examination with Pap test and GC/Chlamydia screening

tests (see 3.3).
Only Female Volunteers at

risk per TG 705.2.4 and TG
710
Screening mammography (see 3.3)
Female Volunteers > 50; see

TG 355
December 2015
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TG 320
Interim Health Evaluation
Tuberculin skin testing or Interferon gamma releasing assay

(see 3.4)
Volunteers at risk; see TG

645
Stool for Ova and Parasites
If clinically indicated; see TG

815
Dental screening (see 3.5)
When adequate dental care

exists; see TG 180
Arrange for evaluation of unresolved health problems (see

3.6)
All Volunteers
Review immunizations status (see 3.7)
All Volunteers
3.1
Update the Health History (Section I of Interim Health Evaluation form)

PCMO reviews health history via the Volunteers PCMEDICS Summary Page to
determine status of unresolved problems and to identify new problems which have
not yet been addressed. The PCMO updates the summary page including allergies,
medications and problems as needed.
1. PCMO interviews the Volunteer focusing on these areas:
Unresolved or new health issues
Health risks or disease exposures
Volunteer health concerns
Immunization status
2. PCMO completes Section I of the Interim Health Evaluation form.

3.2
Weight, Vital Signs and History Guided Examination (Section II of Interim

Health Evaluation Form)
1. Weight and vital signs (temperature, blood pressure, respiratory rate, pulse and
last menstrual period) should be recorded for all Volunteers.
2. A history-guided physical examination should be completed and should
address:
Issues raised in the interim health history
Health conditions that have occurred during service
Other unresolved conditions
3. PCMO documents examination on the PCMEDICS Interim Health Evaluation

form.
4. All labs done including the PPD skin test should be ordered, and lab results
recorded via the PCMEDICS lab tracking feature.
December 2015
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TG 320
5. Scan and upload any related dental, diagnostic, consultation, and/or laboratory
reports and images in the appropriate PCMEDICS document folders according
to TG 214 Attachment B.
3.3
Pelvic and Breast Exams

Peace Corps follows the recommendations of the United States Preventive Services
Task Force (USPSTF)
Screening Pelvic Examination
The screening pelvic exams, including Pap test, are indicated for 1) low risk female
Volunteers who have not had routine cervical cancer screening within the previous 3
years or 2) high risk female Volunteers. (Refer to TG 705 Cervical Cancer
Screening)
Routine annual screening for Chlamydia and gonorrhea via urine or cervical swab is
recommended for all sexually active female Volunteers less than 25 years of age.
Screening for women 25 years and older is also recommended for those at increased
risk for infection. (Refer to TG 710 on annual STI testing)
Screening Mammography
Screening mammography is not available at all Peace Corps posts. Current USPSTF
recommendations are that women between the ages of 50 and 74 get screening
mammography every two years. Prior to service, female applicants age 50 and over
with previous normal mammograms are permitted to waive this recommendation.
(Refer to TG 355 Mammography sections 3 and 4)
3.4
Screening Tests
Tuberculosis Skin Testing (TST)/Interferon gamma releasing assay (IGRA)
Tuberculosis (TB) skin testing using the Intradermal (Mantoux) test is required for
Volunteers who have had contact with persons with known infectious TB or who live
or work in high risk settings. Results should read by the PCMO 48-72 hours after
placement. A reminder can be set up in the PCMOs PCMEDICS calendar to follow-up
for this purpose. If a Volunteer has a history of a positive intradermal test and
appropriate treatment at any time in the past, a new intradermal test is not necessary;
the Volunteer should be screened for symptoms of active Tuberculosis disease.
IGRA can be substituted for TST. FDA approved IGRAs include the T-Spot and
QuantiFERON-TB Gold. (Refer to TG 645 Pulmonary Tuberculosis)
Stool for Ova and Parasites
If clinically indicated, stool examination for ova and parasites should be performed.
(Refer to TG 815 Stool Examination for Parasites)
December 2015
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TG 320
Other Screening Tests

Screening for other conditions is necessary only if risk factors or specific signs or
symptoms are present. Consult the Office of Health Services, Field Support Unit as
necessary.
3.5
Dental Exam
In countries where adequate facilities and expertise exist, annual cleaning and scaling
should be performed. (Refer to TG 180 Dental Policy.)
Medevac is not authorized for the purposes of providing routine preventive dental care.
Volunteers who are returning to the U.S. on home leave may be authorized to have
dental care in the U.S. if adequate care is not available in country.
3.6
Evaluation of Unresolved Health Conditions

Follow-up for health conditions identified during the interim health evaluation should
be arranged and documented in PCMEDICS. PCMOs should consult with local
providers, RMO, Office of Medical Services, or Field Support Unit as appropriate.
3.7
Provide Any Necessary Immunizations

Review the Volunteers current immunization status and provide any needed
vaccinations. (Refer to TG 300 Immunization)
December 2015
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Peace Corps
Technical Guide line 330
POST-SERVICE HEALTH BENEFITS and CLOSE OF SERVICE

or EXTENSION OF SERVICE HEALTH EVALUATIONS
1. PURPOSE
To describe the post-service health benefits infor mation that must be pr ovided to
Volunteers at Close of Service.
To outline the Peace Corps Medical Off icer (PCMO) responsibilities for conducting
Close of Service (COS) health eva luations.
To outline the PCMO respons ibilities for conducting Extens ion of Service (EOS) health
evaluations.
2. B ACKGROUND
Most Returning Peace Corps Volunteers (RPCVs) learn about the ir post-service health
benefits and begin COS hea lth eva luations dur ing COS conferences that occur roughly 60
days pr ior to the Volunteers actual COS.
Not all Volunteers COS with their or igina l tra ining c lass. However, Peace Corps and Cris is
Corps Volunteers must receive health benef its inf or mation and hea lth eva luations when they
leave service, regardless of the reasons or circumstances of COS.
When to Provide Post-Service Health Benefits Information and
Conduct a Close of Service Health Evaluation
Completion of Tour
Early Termination
At the End of a 27-Month Tour

Volunteers complete service after
serving 27 months in a country program.
Resignation
Volunteers may resign their positions at any
time during training or service.
Early COS
Under certain circumstances, Volunteers
are permitted to leave their assignments
up to 90 days before their schedules
COS.
Interrupted Service
Volunteers may close service for reasons
beyond their control, such as country
evacuation or program closure.
At the End of an Extended Tour Some

Volunteers extend their assignments for
up to 13 months beyond their scheduled
COS date.
Administrative Separation
Volunteers may be separated from service due
to unacceptable conduct or policy violations.
(See Technical Guideline (TG) 155 and Peace
Corps Manual Section (MS) 281.)
Medical Separation
Health problems may cause the Office of
Volunteer Support (VS) to separate a
Volunteer from service (see TG 160).
Office of Volunteer Support
January 2016
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TG 330
Post-Service Benefits
Extens ion of Service (EOS) hea lth eva luations are conducted for Volunteers who wish to
extend the ir service for six months or more, or to transfer to another country program.
3. POST-SERVICE HEALTH B ENEFITS

KEY STEPS IN THE ADMINISTRATION OF POST-SERVICE HEALTH BENEFITS
Distribute Post-Service Health Information for Returning Volunteers (ATTACHMENT A).
Issue Form PC-127C Authorization of Payment of Medical/Dental Services authorizations
and explain their use.
Ensure that Volunteers have been issued their Health Benefits Program identification card
and understand its use.
Show the Post-Service/ Federal Employees Compensation Act (FECA) Benefits Video.
Distribute the Post-Service Health Benefits at Glance information sheet.
Distribute the AfterCorps insurance brochure/extension form.
Collect completed AfterCorps insurance extension forms and give them to the post
Administrative Officer (AO).
Ensure that Volunteers have had the opportunity to ask questions about these benefit
programs.
Note: As circumstances dictate, the AfterCorps program and enrollment procedures may be
provided to Volunteers by the PCMO or AO.
Returning Peace Corps Volunteers are covered by a three-tiered health benefit program.
These benefits are:
127C authorization. 127C author izations are used to authorize evaluation of Peace
Corps service-related hea lth conditions;
FECA be ne fits. FECA covers the cost of treatment for service-related health conditions;
and
Afte rCorps ins urance . Afte rCorps is a comprehe ns ive health insurance policy that
covers non-service-re lated medica l pr oble ms.
The following table is a synopsis of each tier of the benefit program. Detailed information
about each type of benefit appears in subsequent sections.
January 2016
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TG 330
POST-SERVICE HEALTH BENEFITS

Covers
Benefit
Mechanism
Time Limit
How Accessed
127C
Authorization
Evaluation of medical and Must be issued and used within

dental health conditions
6 months of COS.
related to overseas
Preferably used with a Peace
service.
Corps Health Benefits
identification card.
May be issued by
PCMOs or VS staff.
FECA
Benefits
Treatment for medical and Claims must be filed within 3

dental conditions related years of COS, or within 3 years
of recognition that a health
to overseas service.
condition is service-related.
Claims are filed through

the VS Post-Service
Unit.
AfterCorps
Insurance
Non-service-related
medical problems.
Specifically:
Pre-existing conditions
not covered by FECA
Conditions that arose
while in the U.S. on
vacation, home leave,
emergency leave, or
medevac
New health problems
after COS
Contact AfterCorps
Customer Service for:
Emergency medical
assistance
Referrals to Network
hospitals, physicians,
and other health
services
Insurance coverage
extensions
Peace Corps pays one month's

premium for all Volunteers.
Volunteers may purchase up to
18 months of additional
coverage for themselves and
their qualified dependents.
3.1 PC-127C Authorizations

At COS the 127C author ization is used to author ize pa yment for :
1. Evaluation of ongoing, unresolved medica l and dental problems;
2. Dental examination as per TG 180 Dental Policy;
3. Specif ic laborator y tests that were not accomplished pr ior to COS or are not
available in country, e.g., stools for ova and parasites, ma mmography, etc.;
4. Readjustment s upport counse ling (three one hour sessions only).
A 127C author ization should be used in conjunction w ith a Peace Corps Health
Benefits ide ntif ication card (see TG 340 section 6 Peace Corps Health Benefits
Program Identif ication Card).
Only eva luations are covered, and only the spec if ic evaluation author ized will be
reimbursed. A 127C cannot be used for me dical treatment, w ith two exceptions;
first, it can be used to author ize a single course of treatment for parasites. In these
cases the author ization should read as follows :
Initial office visit and one follow-up. One course of treatment. Follow-up stool
exams for O & P x 3 post treatment. No further treatment authorized.
January 2016
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TG 330
Second, it can be used to author ize presumptive antire lapse therapy (PART) for
malar ia. In these cases the author ization should read as follows :
Primary care consultation for G6PD testing ( if preservice results not
attached) and presumptive antirelapse therapy (PART) as indicated
A 127C must be issued and used w ithin s ix months of COS. It w ill not be honored
after that time has ela psed.
A 127C may be iss ued by a PCMO, RMO, or VS staff.
The 127C form has three parts. The origina l (hea lth recor d copy) is placed in the
Volunteers health record under In-Ser vice or COS/Post-Service care
depending on when it was issued. The f irst copy (provider copy) is given to the
provider by the Volunteer and the second copy (patie nt copy) is for the Volunteer's
persona l records. The PCMO should ensure that all three copies are legible pr ior to
issue.
After COS, if a Volunteer has questions or pr oble ms with his/her 127C
author ization, he/she should contact the Post-Service Unit in VS.
TG 340 PC-127C For m Author ization for Payment of Medical/Denta l Services
conta ins additiona l guidance on the use of 127C author izations.
3.2 FECA Be ne fits
FECA provides medica l and denta l treatment for health conditions re lated to
Volunteers overseas service.
FECA benef its are administered by the Office of Wor kers Compensation Programs
at the U.S. Department of Labor (DOL). The Post-Service Unit in VS ass ists
Volunteers in f iling c la ims with DOL.
FECA benef its are not guaranteed. The DOL must determine that a health condition
is service-related before a cla im for benef its is accepted.
DOL claims process ing usua lly takes from s ix to 12 weeks. This pr ocess can be
expedited if Volunteers contact the Post-Service Unit as soon as they be lieve they
have a service-related condition requir ing treatment and if they respond quickly to
requests for infor mation from the Post-Service Unit or DOL.
Cla ims must be made within three years of COS or within three years of recognition
of a service-related hea lth condition.
Health pr oble ms resulting from injur ies or illnesses that deve lop in the U.S. while
on vacation, home leave , emergency leave, or on medevac when the Volunteer is
not directly engaged in Peace Corps activity, are not eligible for FECA benef its (see
AfterCorps Insurance in section 3. 3 be low).
The PCMO or Post-Service Unit can provide inf or mation on FECA cla ims
processing and copies of The Post-Service Health Benefits at Glance inf ormation
sheet for Volunteers.
January 2016
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TG 330
3.3 Afte rCorps Pos t-Se rvice He alth Ins urance

AfterCorps is a comprehens ive health insura nce policy des igned spec if ically for
returned Volunteers.
AfterCorps can be activated only at COS. It provides coverage for non-servicerelated hea lth care needs. Specif ically:
1. Pre-existing conditions: Health conditions that existed pr ior to Peace Corps
service that were not affected by Peace Corps service.
2. Travel to the U.S. on personal business: After COS, AfterCorps will cover
health problems that deve loped while a Volunteer was on personal bus iness in
the U.S., e.g. vacation, home leave, e mergency leave, or while on medevac, but
not directly engaged in Peace Corps activity.
3. Healthcare after COS: Returned Volunteers need health ins urance for new
health problems that arise after COS.
Peace Corps pays the first months premium for every Volunteer or Tra inee who
leaves service, regar dless of the reason for COS.
At COS, Volunteers may elect to continue AfterCorps beyond the f irst month.
Volunteers are strongly encoura ged to s ign-up for extended Cor psCare coverage
before they leave countr y.
Payment for extende d coverage may be ma de by check, credit card or through a
deduction in the Volunteers readjustment a llowance.
Returning Volunteers may purchase up to 18 months of additiona l coverage for
themse lves and the ir qua lif ied depende nts when they leave service.
If this polic y lapses for even one month, Volunteers will not be e ligible to re join the
plan.
AfterCorps requires pre-certif ication for medical trans portation other tha n local
ground services and strongly advises Volunteers to conf ir m benef its pr ior to use of
(1) overseas healthcare and (2) U.S. healthcare expected to be more expens ive than
the cost of a phys ic ian off ice vis it.
AfterCorps insurance may not be used to cover medica l expe nses for service-related
conditions covered by 127Cs or FECA. Volunteers with questions on which be nefit
plan to use should contact the Post-Service Unit in VS.
Volunteers who are 65 years of age or older may be eligible for Medicare. They
may choose AfterCorps as their pr imary pla n, but before doing so s hould contact
the Soc ia l Secur ity Administration (SSA) , which coordinates Medicare, to obtain a
full understanding of Medicare coverage and enrollment options. If a Volunteer
who is eligible f or Medicare chooses Medicare as his or her pr imary coverage plan,
AfterCorps coverage will cease. Volunteers should contact AfterCorps Customer
Service for full inf ormation on AfterCor ps coverage issues.
January 2016
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TG 330
The post staff member who pr ovides AfterCorps inf ormation to Volunteers at COS
should hold the AfterCorps broc hure/extens ion f orms. That person should ma intain
a one-year supply of br ochures. Brochures may be reor dered from Post Logistics
and Support D ivis ion (M/AS/PLS) in Washington, DC.
Because the AfterCorps brochure conta ins an AfterCorps Ins urance Identif ication
Card, the br ochures should not be distr ibuted f or inf ormationa l purposes. Persons
who request a brochure for inf ormationa l purposes should be given photocopies of
the brochure.
3.4 He alth Be ne fits Information for Re turne d Voluntee rs
For questions regarding 127C author izations, FECA benef its, or other servicerelated hea lth issues , returned Volunteers should contact the VS Post-Service Unit.
In the U.S., they may dia l 800- 424-8580 (extens ion 1500) , toll free. Outside the
U.S., they ma y call 202- 692-1500.
Volunteers with questions regarding the use of the Health Benefits identif ication
card should contact the Peace Corps Health Benefits Program at 800-544- 1802. For
infor mation on network providers in a particular geographic location, Volunteers
should contact Seven Corners at 800-544- 1802 or vis it Seven C orners online at
www.peacecorps.sevencorners.com.
PCMOs with questions regarding the Health Benef its ide ntif ication card should
contact VS by phone at 202- 692-1500 and ask to be transferred to the Health Care
Resources Program Manager, or by fax at 202-692-1541.
To extend AfterCor ps insura nce coverage, Volunteers should contact the pla n
adminis trator , Seven Cor ners. Their phone numbers are 800-544-1802 in the U.S.,
or 317-582- 2609 outs ide the U.S. Volunteers may use Seven Cor ners' web site to
see a copy of the AfterCorps policy or to check persona l coverage as follows. Go to
www.peacecorps.sevencorners.com; clic k the AfterCor ps button.
For inf ormation or assistance with a medical e mergency or a non-service-related
health problem, retur ned Volunteers enrolled in AfterCorps should contact
AfterCorps. In the U.S., they may dia l 800- 544-1802. Outs ide the U.S., they may
call 317-582- 2609.
January 2016
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TG 330
4. CLOSE OF SERVICE HEALTH EVALUATIONS

KEY STEPS IN THE COS HEALTH EVALUATION
Update the health history.

Conduct screening labs and tests.
Consider additional risk/exposure-based testing, as appropriate.
Complete a comprehensive physical examination.
Complete a dental examination.
Authorize post-service evaluation of unresolved health problems.
Provide final medical clearance prior to COS.
The pur pose of COS health eva luation is to:
Evaluate, document, and, where poss ible, complete treatment of curre nt medica l
proble ms;
Identify the need for additiona l evaluations after COS;
Provide 127C author izations for necessary post-service medical and denta l eva luations;
Provide doc umentation to support workers compensation cla ims;
Provide f ina l medica l c learance to COS.
COS health evaluation is not required for PCT who c loses service dur ing staging, unless
extenuating c ircumsta nces exist. VS will be consulted f or specia l s ituations where a COS
health evaluation may be necessary.
4.1 He alth His tory
The PCMO is respons ible for completing the review and update of the Volunteers
health record, eve n if a loca l consultant is used to perfor m the phys ical exa mination.
Steps
1. Volunteer completes Section 1 of PC-1790 (COS/EXT) C lose of Service or
Extens ion of Service Medica l Eva luation form (ATTACHMENT C).
2. PCMO reviews the health record and completes the health history w ith the
Volunteer in order to:
Clar ify and gather additiona l inf ormation on a ll unresolved medica l

proble ms;
Ask the Volunteer whether he/she has any other hea lth concerns; and
Review any additiona l spec if ic health r isks or exposures.
January 2016
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TG 330
4.2 COS Labs and Tests

All required COS labs should be performe d no ear lier than 90 days and no later
than 7 days pr ior to COS.
All routine COS screening la bs/tests must be identif ie d as COS specimen on the
laborator y requis ition slip.
Whenever poss ible, lab results should be reviewed with the Volunteer at the time of
the phys ical exam, or pr ior to departure , so that further testing or referrals may be
performed before the COS date (see section 4.6 be low).
A clinica l breast exam (CBE) is indicated for a ll fema le Volunteers at COS. Pelvic
examinations should be cons idered for all fema le Volunteers whose last Pap smear
was norma l and was greater than 2-3 years pr ior to COS. Pelvic examinations are
indicated for a ll high r isk (See TG 705) fema le Volunteers whose last Pap smear
was one year or greater prior to COS. The pe lvic exam should include a bimanua l
pelvic exam, Pap smear, and GC/C hlamydia test.
For m PC-1790: COS/EXT section 2, parts D and E guide the PCMO when
performing la b tests. The require d tests are outlined in the chart below.
COS SCREENING LABS AND TESTS
All Volunteers, regardless of time since pre-service examination
G6PD, in malarial areas only if not previously documented.

Stool for ova and parasites (x3), in countries where intestinal parasites are endemic.
TB PPD skin test (TST); if Volunteer has been in country > 3 months or if medically
indicated (TG 645). If Volunteer is past mid-service, then a PPD is indicated if > 3 months
since the mid-service PPD. IGRA (T-Spot or QuantiFERON-TB Gold) can be substituted
for TST.
All Volunteers, if more than 12 months since pre-service examination, or if medically
indicated
Urine dipstick (Multistick).

Hemoglobin or hematocrit.
Pap smear cytology, if indicated, See above.
GC/Chlamydia testing independent of a pelvic examination, if indicated based on the
sexual history obtained by the PCMO.
Female Volunteers over age 50
Mammography, as indicated in TG 355

All Volunteers over age 50
Guaiac-based fecal occult blood test (gFOBT) (x3)
January 2016
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TG 330
On a case-by-case basis, laborator y screening be yond the required tests is occasiona lly
indicated. Such screening may be warranted if there is a r isk of exposure to a particular
condition and early diagnos is of the condition would be be nefic ia l, e.g., STDs. Refer to
the appropr iate TG for advice on screening for s pecif ic conditions. Consult the RMO or
VS for questions regarding additiona l screening tests at COS.
4.3 HIV Tes ting at COS
HIV Testing
All Volunteers, if more tha n 12 months s ince pre-service examination, should be
encouraged to have HIV testing at COS. HIV testing is not mandatory.
COS HIV testing can be accomplis hed us ing the rapid test kits or at a reputable medica l
laborator y.
If rapid test or screening test performed in country is indeterminate or pos itive for HIV,
medical off icers must inf or m and counse l the Volunteer and perfor m conf ir mator y HIV
test. Medical off icers should als o inf orm VS.
For ms 127C and PC-209B Author ization f or Medical Examination and Labs should
not be used to author ize HIV testing at COS unless it is impossible to obta in a sample
in country.
Schistosomiasis Testing
Routine screening testing f or Schistosomiasis at COS is no longer required or
recommended. All PCVs who have served in endemic areas, unless a medica l
contra indication exis ts, should be empir ically treated no greater than 72 hours pr ior to
departure from post. If there is uncertainty as to whether a post is in an endemic area,
check with the Chief of Epidemiology and Surve illance in VS.
4.4 Phys ical Exam
Use PC-1790 (COS/EXT) (ATTACHMENT C) for the COS phys ical exam.
Perform COS phys ica l examinations within 90 days of COS.
Perform a comprehens ive phys ica l examination. This should be performe d by the
PCMO (if the PCMO is a phys ic ian, nurse practitioner , or phys ic ian ass istant) or by
the RMO or a referral consultant. Referral consultants used for COS examinations
must pr ovide a thor ough eva luation.
Have the PC-1790 (COS/EXT) for m co-s igned by an RMO or a Medical Advisor in
VS if the phys ica l examination is perfor med by a Nurse Practitioner or Phys icia n
Assistant. The Department of Labor (DOL) requires all documentation submitted
for FECA cla ims to be s igned or co-s igned by a phys ic ian.
January 2016
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TG 330
Steps
1. Complete PC 1790 (COS/EXT) section 2, parts A and F, even if a loca l consultant
performs the phys ica l exam.
2. Address all items reported on the health his tor y dur ing the phys ical exam. For
example , if the Volunteer reports a histor y of thyroid abnorma lities, a thyr oid exa m
should be perfor med and documente d.
3. Provide treatment for any medica l pr oble m that needs immediate attention.
Whenever poss ible, establis h a treatment plan that a llows the pr oble m to be
addressed before the Volunteers departure.
4. Issue a 127C for any hea lth condition that w ill require post-service evaluation in the
U.S. Expla in the use of the 127C and the Health Benefits Program identif ication
card.
5. If a Volunteer is advised to return to the U.S. for additional eva luation or treatment
within a certain period of time after COS, docume nt this infor mation in PC-1790
(COS/EXT) section 2, Part F. Other travel recommendations or functiona l
restrictions should a lso be recorded.
Medications
Provide Volunteer with a 30 day supply of prescription medications and required

ove r-the -counte r (OTC) me dications for use following COS.
Immunizations
Booster doses of appr ove d vaccines ma y be given to Volunteers at COS who do not
plan to retur n to the U.S. within 30 days of COS and who me dically require the
vaccine for trave l in a destination countr y (see TG 300 Technical Reference
Infor mation on individua l vaccines).
A primary series of an approved vaccine may be initiate d for Volunteers at COS
who do not plan to return to the U.S. within 30 days of COS and medica lly require
the vaccine for trave l in a destination countr y. The vaccine must be ava ilable in the
Health Unit or thr ough another relia ble local source, e.g., Departme nt of State or
Ministr y of Health clinic.
Yellow fever vaccine can only be given at off ic ia l ye llow fever vaccination centers.
Peace Corps Health Units are not off ic ia l ye llow fever vaccination centers.
Malaria Prophylaxis/Suppression
For the Volunteer serving in a ma laria endemic area, PCMOs should pr ovide the
Volunteer with the follow ing:
June 2012
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TG 330
Malar ia prophylaxis/s uppression, inc luding presumptive anti-relapse therapy

(PART) (Primaquine), according to the guidance outlined in TG 840
Prevention of Ma lar ia.
Handout titled Instr uctions for Volunteers: COS Guide lines for Preventing
Malar ia (see TG 330, Attachment G).
G6PD testing: PCMOs must follow the guidance in TG 840 G6PD
Testing when issuing pr imaquine to Volunteers. All Volunteers should
have been tested for G6PD def ic iency pr ior to enter ing PC. Testing should
only be repeated at COS if the pre-service results are not docume nted in the
medical recor d and those results are not obta ina ble. Volunteers who ha ve
not been tested for G6PD def icie ncy pr ior to COS should not be iss ued
pr imaquine and they should be pr ovided w ith a 127C author ization for ,
Primary care consultation for G6PD testing and presumptive anti-rela pse
therapy (PART) as indicated.
Use of the PC-209B

In the rare circumstance that a COS phys ica l examination cannot be scheduled pr ior
to departure; a PC-209B (ATTACHMENT F) should be issued author izing a
complete history, phys ica l exam and appropr iate la b tests. A PC-209B must be
issued with a PC-1790 (COS/EXT), and must be used within 60 days of COS.
4.5 De ntal Exam
Dental examinations and bite-wing x-rays should be provided f or all Volunteers if 12 or
more months have ela psed since their pre-service denta l examination.
Dental examinations should be performe d in countr y whenever poss ible.
Simple denta l treatments , such as fillings and c leanings, should be perfor med at this
time. More complex pr ocedures should generally be done after COS, unless excelle nt
and affordable in-c ountry services are available.
The denta l examination and any treatme nts provided should be recorded by the
examining dentist on the PC-1790 (Denta l) for m.
If qua lif ied dental care is not ava ilable in countr y, the denta l examination may be
author ized through a 127C. This author ization s hould read:
For dental examination and routine prophylaxis only (including bite-wing x-rays and
other views as indicated). Record the examination on the PC-1790 (Dental) form
attached. If dental treatment is indicated please describe in detail and estimate cost.
No treatment authorized at this time.
June 2012
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TG 330
4.6 Final Me dical Cle arance to COS

Volunteers should receive f ina l medica l c learance to COS within 72 hours of the ir
antic ipated COS date. At the fina l c learance, all Volunteers must complete, s ign,
and date the Volunteer Health Program COS Checklist (ATTACHMENT B ),
and the completed Checklist must be placed in the Volunteer health record.
Completion of the COS Checklist ens ures that the Volunteer has received the health
instruction and health benef it infor mation needed for the ir trans ition from Peace
Corps. It also conf ir ms that the Volunteer does not have any hea lth conditions that
require immediate medica l attention by Peace Corps.
PCMOs may modify the COS Checklist to facilitate their COS pr ocedures ,
however, no portion of the checklis t can be deleted when modifying the for m.
Volunteers who have an urgent need for medica l or ps ychiatr ic care, an unstable
medical condition, or a condition that cannot be managed by issuing a 127C , should
not be c leared to COS. The PCMO should contact VS to cons ider appropr iate
management of such cases. Consult VS for any unstable me dical or psychiatr ic
condition for which hospita lization, medevac or any immediate intervention may be
necessary.
Often, a Volunteer with an unresolved but stable medica l condition is advise d to
seek medica l attention pr omptly after COS. This may require modif ication or
cancellation of post-service trave l. The Volunteer can be given f ina l medical
clearance with recommendations for post-service trave l and medical care.
Health Benefits
Ensure that the Volunteer has been give n a copy of Post-Service Health I nfor mation
for Returning Volunteers (ATTACHMENT A).
Issue 127C author izations and expla in their use.
Ensure that the Volunteer has a Health Benefits identif ication card and understands
its use.
Ensure that FECA benef its are understood.
Ensure that the Volunteer has been give n a copy of the AfterCorps health ins urance
brochure/extens ion for m. Encourage the Volunteer to carefully cons ider extens ion
of AfterCorps health insurance coverage beyond the first month.
Medical and Dental Care

Ask the Volunteer whether he/she has any outstanding hea lth concerns.
Give the Volunteer copies of the results of any exam or test perfor med in country
that will require follow-up in the U.S.
Give the Volunteer all medica l x-rays , inc luding mammograms , in the Peace Corps
Health Unit records.
June 2012
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TG 330
Update the Wor ld Hea lth Organization (WHO) Internationa l Certif icate of
Vaccination and return it to the Volunteer.
Obtain any medical equipment previous ly issued to the Volunteer.
Ensure the Volunteer has received a 30-da y supply of all prescription and required
OTC medications.
Ensure the Volunteer has received immunizations required f or post-service trave l
(see Section 4.4 above)
Ensure Volunteers serving in ma lar ia endemic areas have received me dications for
malar ia pr ophyla xis/suppress ion (see Section 4. 4 above)
If the Volunteer has refused to have blood drawn for HIV testing, this will be
documented in the hea lth record.
If the Volunteer has refused to undergo a COS health eva luation, he/she must read
and sign a copy of Ref usal to Undergo a COS Health Eva luation
(ATTACHMENT I).
If medically indicated, advise the Volunteer to return pr omptly to the U.S.
Document this advice in the health record.
Have the Volunteer read, complete, and sign a copy of V olunteer Health Program
COS Checklis t (ATTACHMENT B ).
Final Documentation in the Health Record
Document pending la bs. Record where each specimen was sent and the date sent.
Document denta l exams , mammography, and other eva luations to be done after
COS.
Comment on all unresolved medical conditions requir ing f ollow-up in the U.S.
File the health record copy of a ll 127Cs and any 209B issued.
Update the problem list.
File the Volunteer Health Program COS Checklis t.
Document the dispos ition of medica l x-rays.
Return Health Record to VS
Within 30 days of COS, package health record, mark "Me dical Eyes Only," and
send to:
Peace Corps Office of Volunteer Support
Medical Records Department
1111 20th Street, NW
Washington, DC 20526
4.7 Post-COS Lab/Tes t Res ults

June 2012
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TG 330
When laboratory test results are received after a Volunteer has closed service,
PCMOs should use the chart be low to determine how to document results and
initiate follow-up. When ava ilable , PCMOs should provide VS w ith the Volunteer's
SSN, home address, and te lephone number if follow-up is needed.
FOLLOW-UP OF POST-COS TEST RESULTS
Health Record Is Still In the
Health Unit
Health Record Has Already

Been Returned to Medical
Records Department
Urgent Follow-Up
Required
Document in the health record.

Do not file the report in the
record. Fax it to VS at 202-6921541. Phone the Post-Service
Unit (Ext.1500) to assure the fax
has been received. Place the
report in an envelope along with
other late results. Mark the
envelope, "Attn. Post-Service
Nurse." Enclose the envelope of
late results with health records.
Address the package to Medical
Records as shown below.
Fax the report with pertinent

medical history to VS at 202692-1541. Phone the PostService Unit (Extension 1500) to
ensure the fax has been
received. Place the report in an
envelope marked "Attention
Post-Service Nurse." Address
the envelope of late results to
Medical Records as shown
below.
Non-Urgent Follow Up Required

Do not file the report in the
record. Place the original report
in an envelope along with other
post-COS results. Mark the
envelope, "Attention PostService Nurse." Enclose the
envelope of late results with
health records. Address the
package to Medical Records as
shown below.
Place the report in an envelope

marked "Attention Post-Service
Nurse." Address the envelope of
late results to Medical Records
as shown below.
Follow -Up
Not Required

File the original report in the
health record. Package all health
records and send to Medical
Records as shown below.
Document on the report No

Follow-Up Required. Sign and
date the report and place the
report in an envelope marked
"Attention Post-Service Nurse."
Address the envelope of results
to Medical Records as shown
below.
Post-COS Laboratory
Test Results
June 2012
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TG 330
4.8 COS Forms

Index of COS Health Evaluation Forms
Attachment A: Post-Service Health Information for Returning Volunteers
Attachment B: Volunteer Health Program COS Checklist

Attachment C: PC-1790 Close of Service or Extension of Service Medical Evaluation
Attachment D: PC-1790 Dental Form
Attachment E: PC-127C Authorization for Payment of Medical/Dental Services

Attachment F: PC-209B Authorization for Volunteer Medical Examination and Labs
Attachment G: Instructions for Volunteers: COS Guidelines for Preventing Malaria
Attachment I: Refusal to Undergo a COS Health Evaluation
5. EXTENSION OF SERVICE HEALTH EVALUATION

Extens ion of Service (EOS) hea lth eva luations are completed w ithin 90 days of the
PCVs original COS date for Volunteers who wis h to extend for s ix months or more , or
to transfer to another countr y pr ogra m. Volunteers extending for less than s ix months
should have a review of the ir medica l record to eva luate any outstanding issues (see
below) but the COS health eva luation can be completed as close as poss ible to the ir
actual COS date.
VS must be cons ulted for recomme ndations , not approva l, for any undia gnosed,
unresolved, or potentia lly recurrent health conditions that may interfere with the
Volunteers ability to rema in in countr y or transfer. This inc ludes conditions that would
benefit from additiona l eva luation or treatment in the U. S. by iss uing 127-C. Cons ult
VS if there are questions about the medica l f itness of the Volunteer to continue to
serve.
Receiving PCMOs/PCMCs are responsible for checking to make sure all me dical
accommodations ma de in or iginating countr y can be uphe ld/continued in receiving
countr y.
5.1 He alth His tory, Scree ning Labs and Phys ical Examination
Use PC-1790 (COS/EXT) (ATTACHMENT C). The extension of service table on
page 4 of PC-1790 must be completed in a ll cases.
Perform all screening labs and tests indicated in PC-1790 (COS/EXT) section 2, parts
D and E, except HIV. Some required screening tests, e.g., mammography, may not be
June 2012
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TG 330
available in country. This may require issuing a 127C and having the Volunteer
complete a test while on home leave.
5.2 HIV tes ting
HIV testing is not required for extens ion or transfer. HIV testing at extens ion of service
follows the same criter ia as all in-service HIV testing, and should be cons idered based
on r isk factors or c linica l f indings (see TG 710 STD/HIV Prevention).
5.3 Me dical Approval to Exte nd or Trans fe r
Medical approval f or extens ion or transfer uses criter ia establis hed in TG 160 Medica l
Separation. VS must be consulte d for any undia gnosed, unresolved, or potentia lly
recurrent health conditions that ma y interfere with the Volunteers ability to rema in in
countr y or transfer.
If a Volunteer is transferr ing to another country, the PCMO should disc uss with VS and
the receiving countrys PCMO any s ignif icant past me dical his tor y, spec ia l medica l
needs, or accommodation require ments.
5.4 Provis ional Me dical Approval to Exte nd
Provis ional medica l approva l to extend is given by VS only, and ma y be give n pending
treatment or tests results if the Volunteer is asymptomatic and can complete all
screening tests in a reasonable per iod of time.
Provis ional medica l approva l should not be granted when:
signs or symptoms suggestive of an undiagnosed condition exist;
pending eva luation of an undiagnosed or unresolved medical problem; or
for transfer to another countr y pr ogram.
Provis ional medica l approva l may be rescinded if a screening test result requires
follow- up unava ilable in country or the result precludes medica l appr ova l to extend. In
this case, the Volunteer should be granted e ither a COS or a medical separation.
Consult VS for guidance.
June 2012
Page 16
TG 330 ATTACHMENT A
POST-SERVICE HEALTH INFORMATION

FOR RETURNING VOLUNTEERS
Please carry this important handout in your personal belongings.
Post-Service Health Benefits

Returning Volunteers are covered by a three-tiered health benefits program. Two mechanisms Peace
Corps authorizations (PC-127C) and Federal Employee Compensation Act (FECA) benefits cover
service-related medical expenses. The third AfterCorps insurance completes the benefit package by
giving you access to an affordable medical policy you can use to meet non-service-related health care
expenses while transitioning into private health insurance.
This table is a synopsis of your health benefits program. Detailed information about each mechanism
appears in sections below:
POST-SERVICE HEALTH BENEFITS
Benefits
Mechanism
Covers
Time Limit
How Accessed
PC-127C
Authorizations
Evaluation of medical and

dental health conditions related
to overseas service.
Must be issued and used

within 6 months of COS.
Preferably used with a Peace
Corps Health Benefits
Identification Card.
May be issued by PCMOs or

the Office of Health Services
(OHS) staff.
FECA
Benefits
Treatment for medical and

dental conditions related to
overseas service.
Claims must be filed within 3

years of COS or within 3 years
of recognition that a health
Claims are filed through OHS

Post-Service Unit.
AfterCorps
Insurance
Non-service related medical

problems.
Specifically:
Pre-existing conditions
not covered by FECA
Conditions that arose
while in the U.S. on
vacation, home leave,
emergency leave or
medevac
New health problems
after COS
Peace Corps pays one months

premium for all Volunteers.
Volunteers may purchase an
additional 2 (two) months of
coverage for themselves and
their qualified dependents
while transitioning to private
insurance (Affordable Care
Act or parents private
insurance).
Contact AfterCorps Customer

Service for
Emergency medical
assistance
Referrals to Network
hospitals,
physicians, or other
health services
Insurance coverage
extensions
PC 127C Authorizations
A 127C is used to authorize payment of expenses for medical and dental evaluations of health
conditions that are related to your overseas service.
May 2015
TG 330 ATTACHMENT A
Only evaluations are covered, and only the specific evaluation authorized will be reimbursed. A 127C
cannot be used for medical treatment.
You must use a 127C within 6 months of your close of service (COS) date. It will not be honored
after that time has elapsed.
A 127C may be issued by a PCMO, a Regional Medical Officer (RMO) or Office of Health Services
(OHS) staff. The form has three parts. The one copy is kept with your Peace Corps health record. You
should give a copy to the healthcare provider with whom you consult and keep a copy for your
personal records.
For questions regarding 127C authorizations, FECA benefits or other service-related health issues,
you should contact the OHS Post-Service Unit at psu@peacecorps.gov. In the U.S., you may call (toll
free) 855-855-1961, extension 1540, option 7. Outside the U.S. you may call 202-692-1540, option 7.
A 127C authorization should be used in conjunction with your Peace Corps Health Benefits
identification card. For questions regarding the use of the Health Benefits ID card, you should contact
OHS Post-Service Unit at psu@peacecorps.gov or 855-855-1961, extension 1540, option 7. For
information on network providers in a particular geographic location, you should contact Seven
Corners at 800-544-1802 or visit their website at www.peacecorps.sevencorners.com.
To extend AfterCorps insurance coverage, you should contact the plan administrator, AfterCorps.
Their phone numbers are 800-544-1802 in the U.S. or 317-582-2609 outside the U.S. You may use
Seven Corners website to see a copy of the AfterCorps policy or to check personal coverage (go to
www.peacecorps.gov.sevencorners.com and click the AfterCorps button).
For information or assistance with a medical emergency or a non-service-related health problem, returned
Volunteers enrolled in AfterCorps should contact AfterCorps directly. In the U.S. they should call 800544-1802. Outside the U.S., they may call 317-582-2609.
Federal Employees Compensation Act Benefits (FECA)
FECA pays for medical treatment for health conditions related to your overseas service.
FECA benefits are administered by the Office of Workers Compensation Program at the U.S.
Department of Labor (DOL). The Post-Service Unit in OHS can assist you in filing claims for
benefits.
FECA benefits are not guaranteed. The DOL must determine that your health condition is
service-related before a claim for benefits is accepted.
DOL claims processing usually takes from six to twelve weeks. This process can be expedited if
you contact the Post-Service Unit as soon as you believe you have a service-related condition
requiring treatment and if you respond quickly to requests for information from the Post-Service
Unit or DOL.
Claims must be made within 3 years of COS or within 3 years of recognition of a service-related
health condition.
Health problems resulting from injuries or illnesses that develop in the U.S. while you are on
vacation, home leave, emergency leave or on medevac but not directly engaged in Peace Corps
activity are not eligible for FECA benefits (see AfterCorps insurance below).
The Post-Service Unit in OHS can provide information on FECA claims processing. You can get
additional information at www.peacecorps.gov/resources/returned/healthben/feca/
May 2015
TG 330 ATTACHMENT A
AfterCorps Insurance
AfterCorps is a comprehensive health insurance policy designed specifically for returned

Volunteers
AfterCorps can be activated only at COS. It provides coverage for non-service related healthcare
needs, specifically:
1. Pre-existing conditions: Health conditions that existed prior to Peace Corps service that
were not affected by Peace Corps service.
2. Travel to the U.S. on personal business: After COS, AfterCorps will cover health problems
that developed while a Volunteer was on personal business in the U.S., e.g. vacation, home
leave, emergency leave or while on medevac, but not directly engaged in Peace Corps
activity.
3. Healthcare after COS: Returned Volunteers need health insurance for new health problems
that arise after COS.
Peace Corps pays the first months premium for you when you leave service.
At COS, you may elect to continue AfterCorps for two months of additional coverage. You may
also enroll and extend benefits for qualified dependents.
Payment for extended coverage for yourself and for qualified dependents may be made by check,
credit card or through a deduction in your readjustment allowance.
AfterCorps requires re-certification for medical transportation other than local ground services
and strongly advises Volunteer to confirm benefits prior to use of (1) overseas healthcare and (2)
U.S. healthcare expected to be more expensive than the cost of a physician office visit.
You may not use AfterCorps insurance to cover medical expenses provided for under 127C
authorizations or FECA. If you do not know which benefit plan to use, contact the Post-Service
Unit in OHS.
Volunteers who are 65 years of age or older may be eligible for Medicare. They may choose
AfterCorps as their primary plan, but before doing so should contact the Social Security
Administration, which coordinates Medicare, to obtain a full understanding of Medicare coverage
and enrollment options. If a Volunteer who is eligible for Medicare chooses Medicare as his or
her primary coverage plan, AfterCorps coverage will cease. Volunteers should contact
AfterCorps Customer Service for full information on After Corps coverage issues.
Peace Corps pays only for the first months premium on your AfterCorps insurance. Before you leave
service, you will be given an insurance card and an application that allows you to purchase up to 2
(two) months additional coverage for yourself and for your qualified dependents.
Peace Corps strongly encourages you to sign-up for extended AfterCorps coverage before you leave
country. If this policy lapses, for even one month, you will not be eligible to rejoin the plan. You
may alternatively transition immediately into private insurance through the Affordable Care Act
(www.healthcare.gov) or your parents insurance plan (if eligible).
May 2015
TG 330 ATTACHMENT A
Health Information before You Leave Country

Before you leave country, you may ask your Peace Corps Medical Officer (PCMO) to let you review your
health record. You should confirm that all significant health problems you had in country are
documented. If you have a problem that cannot be resolved before you depart, the PCMO will give you a
127C authorization. This form authorizes and evaluation of your condition by a medical professional.
Important Contact Information

Health Information after You Leave Country
For questions regarding 127C authorizations, FECA benefits or other service-related health issues,
contact the Post-Service Unit in OHS at psu@peacecorps.gov. In the U.S. call 1-855-855-1961,
extension 1540, option 7 (toll free). Outside the U.S. call 202-692-1540, option 7.
For questions regarding the use of the Seven Corners Health Benefits identification card. Contact
the Peace Corps Health Benefits Program at 800-544-1802. For information on Network providers
in a particular geographic location, see www.peacecorps.sevencorners.com. Numbers are also
listed on the Health Benefits identification card and the Instructions for Use information sheet.
To extend AfterCorps insurance coverage, contact the plan administrator, Seven Corners. Their
phone numbers are 800-544-1802 in the U.S. or 317-582-2609 outside the U.S. You may use
Seven Corners website to see a copy of the AfterCorps policy or to check personal coverage. (Go
to www.peacecorps.sevencorners.com and click the AfterCorps button.)
For information or assistance with a medical emergency or a non-service-related health problem,
returned Volunteers enrolled in AfterCorps should contact AfterCorps Assistance at 800-544-1802
or 317-582-2609.
May 2015
TG 330 ATTACHMENT B
VOLUNTEER HEALTH PROGRAM COS CHECKLIST

All Peace Corps and Peace Corps Response Volunteers and Trainees must complete, sign, and date the checklist below. This
must be done prior to leaving service, preferably within 72 hours of departure from country, regardless of reason for COS. Medical
Officers must place the completed checklist in the Volunteer's health record.
Name:
Post-Service Plans (check all that apply)
Return to the US within 30 days.
Travel for more than 30 days before returning to the US.
Remain in country for more than 30 days before returning to the US.
Other. Please describe:
My estimated date of return to the US is:
Between now and my return to the US, Peace Corps can leave messages for me at (phone and e-mail):
Health Information (please initial each statement and sign and date below)
I have received and reviewed Attachment A Post-Service Health Information for Returning Volunteers. I understand my postservice health benefits.
I have been given PC-127C forms for medical/dental evaluations after return to the US. I understand that it is my responsibility
to have these evaluations performed within six (6) months of my close-of-service date.
I have received a Health Benefits Program identification card to be used with the PC-127C forms.
I have been shown the Post-Service/FECA video and/or have received information on Post-Service Health Benefits Program
available at the following internet address: www.peacecorps.gov/resources/returned/healthben/feca/
_____
I understand my rights and responsibilities under FECA.

I have received an AfterCorps insurance card valid for the first 30 days after my close-of-service. I have had an opportunity to
extend my AfterCorps insurance for up to 2 additional months while transitioning to private medical insurance.
_____
If serving in a malaria endemic area: I have received and reviewed Attachment G Instructions for Volunteers: COS
Guidelines for Preventing Malaria. I have been instructed in, and understand, the necessity of continuing my malaria
prophylaxis after leaving malaria endemic areas:
Chloroquine, Doxycycline or Mefloquine: four weeks (28 days)
Malarone: one week (7 days)

In addition, I have been instructed in, and understand, the rationale for taking primaquine for two (2) weeks starting:
Chloroquine, Doxycycline or Mefloquine: fourteen days after leaving malaria endemic areas
Malarone: seven days after leaving malaria endemic areas
_____
If serving in a schistosomiasis endemic area: I have received and reviewed Attachment J Praziquantel Medication
Information Sheet. I have received and taken anti-schistosomal medication within 72 hours of my departure from country.
I have been given my yellow WHO International Health Card, and it is up to date.
I have not had a significant change in my health since my close-of-service health evaluation. (If change has occurred, please
check ____ and comment on the reverse of this form.)
Signature
________
May 2015
Date
PC-1790 (COS/EXT)
Peace Corps
Close-of-Service or
Extension-of-Service
Medical Evaluation
Name: (Last, First, Middle Initial
Please use this form when conducting a close-of-service

or extension-of-service medical examination. All items
must be completed as instructed.
This information will be used to assist in providing
appropriate medical follow-up after Peace Corps
service and to facilitate Workers Compensation
claims.
Sex M
Social Security Number
Date of Birth (Mo/Day/Yr)
Country of Service
Date of Exam (Mo/Day/Yr)
Telephone No.
Home/permanent address
Incomplete information may interfere with post-service

health care.
To be completed by volunteer
Section One
I. Health History
A. Instructions to Volunteer
Please answer each question by indicating if you have experienced any of the following during Peace Corps
service by checking No, Yes (Resolved), or Yes (Current). Comment in the space provided.
Symptoms or problems during Peace Corps service
Weight gain or loss of more than 10 pounds
Frequent or severe headaches
Fainting spells or blackouts
Vision problems, eye injuries or disorders
Hearing problems
Persistent cough
Chest pain or chest pressure
Shortness of breath or wheezing
Repeated episodes of indigestion, heartburn, or stomach pain
Frequent diarrhea
Frequent constipation
Frequent or painful urination
Blood in your urine
Repeated episodes of back or neck pain
Muscle, bone, or joint injuries
Painful or swollen joints
Breast lump or mass, or nipple discharge
Skin problems (e.g. eczema, dermatitis)
Change in color or size of a mole or other growth
A sore which does not heal
Frequent sadness or feelings of depression
Frequent or severe nervousness or anxiousness
Frequent sleeplessness or insomnia
Use of cigarettes or other tobacco products
(Females) Gynecologic symptoms or disorders
No
Yes
(Resolved)
Yes
(Current)
Volunteer Comments
SSN
B. List all other current problems not described in Section A
C. List all current medications, including over-the-counter medications/preparations

Name
Dose
Frequency
D. List all medication or vaccine allergies

Name of medicine/vaccine
Type of reaction
To be completed by PCMO or examining physician
Section Two
II. Review of History and Medical Evaluation

A. Review of Medical History
Review the medical history provided in Section I. Use the space below to provide additional comments as
necessary. Ensure that all problems that occurred during service are well documented in the health record or
on this form.
B. Measurements and Other Findings

Height
Weight
Blood
Pressure
Pulse
Hearing
Gross Vision
Uncorrected
Right 20/___
Left 20/____
feet/inches
lbs.
mmHg
(resting)
bpm (resting)
Corrected
Right 20/___
Left 20/____
(whisper test
of other
gross test)
Revised April 2007
Page 2 of 4
SSN
C. Clinical Examination
To be completed by PCMO or examining physician
Normal
Abnormal
Notes: Describe each abnormality in detail
Check each item in appropriate column. All

systems must be examined.
Enter item number before each comment. Use

additional sheets if necessary.
1. Head and neck

2. Nose, sinuses
3. Mouth and throat
4. Thyroid
5. Ears
6. Eyes (include fundoscopic exam)
7. Lungs and chest
8. Breasts
9. Cardiac (rhythm and abnormal heart sounds)
10. Peripheral pulses
11. Abdomen
12. Prostate exam (men, over 50 only)
13. Anus and rectum
14. Genitalia (include hernia)
15. Pelvic exam (females only)
16. Spine
17. Musculoskeletal
18. Neurologic
19. Skin, lymphatics
20. Identifying marks, scars, tattoos
21. Psychiatric (specify any significant cognitive or
behavioral observations)
D. Laboratory Findings (PCMO: For any test not performed/ordered document rationale in Section F on page 4)
Urinalysis
Hematocrit OR Hemoglobi
G6PD Status
Tuberculin Test (5 IU PPD)
(check one)
n
If terminal prophylaxis with
Date read
mm of induration
Albumin
primaquine is indicated.
Sugar
Normal Deficient
If deficient, do not dispense
primaquine.
Blood
Other
Do not report negative. Size of induration

must be noted. Include
Grams
Stool for ova and

parasites (3x)
Schistosomiasis
serology
PAP smear
cytology results
Chlamydia/GC
HIV serology
(check one)
If intestinal parasites are
endemic
(check one)
Indicated if PCV is leaving
or has traveled to an
endemic area
(check one)
(check one)
(check one)
Specimens to
_____________________
On Date:______________
127C issued
209B issued
Results attached
Specimens to CDC
On Date:______________
Specimens to
_____________________
On Date:______________
Specimens to
_____________________
On Date:______________
Specimens to
_____________________
On Date:______________
127C issued
209B issued
Results attached
127C issued
209B issued
Results attached
127C issued
209B issued
Results attached
127C issued
209B issued
Results attached
Revised April 2007
Page 3 of 4
SSN
E. Required Tests for Volunteers 40 Years and Older

(not required of other Volunteers unless clinically indicated)
Stool Test for Occult Blood x 3(for PCVs > 50 yo)
Pos
Pos
1. Date ________________________
Pos
2. Date ________________________
3. Date ________________________
Neg
Neg
Neg
Mammogram (for females over 40 years old)
Mammogram to be performed in the U.S. after COS
127C issued
209B issued
F. Summary of the Medical Examination and Additional Comments

The information requested is collected under the authority of the Peace Corps Act, 22 U.S.C. 2501 et Seq., for the purposes of documenting
the basis for requested payments. Disclosure of this information is voluntary, but failure to do so will make it impossible for the Peace Corps to
pay for these services. This information may be used for the routine uses described in the Privacy Act, 5 USC 552a, and in the Federal
Register at 65 Fed. Reg. 53,722 (September 5, 2000) and 50 Fed. Reg/ 1950, 1962 (January 14, 1985) regarding Peace Corps system of
records PC-17 (volunteer records). It may also be subject to the Health Insurance Portability and Accountability Act (HIPAA).
Incomplete forms may be returned and may delay processing!
*Important*
COS is complete only when:

Date
PCMO/Physician Signature
(Must be signed or co-signed by a licensed M.D. or
D.O. if exam performed by PA or NP)
1 Volunteer has completed Section I (Health

History).
2 PCMO or examining physician has completed

Section II
PCMO/Physician license number
State
3 Appropriate laboratory studies have been performed

or ordered.
4 The Summary of Medical Examination has been
completed.
5 Examining physician has signed the report or has cosigned the clinical examination performed by NP or PA.
Physician address and phone number

(unless performed by PCMO)
HIPAA and Privacy Act Notice: The information requested is collected under authority of the Peace Corps Act for the purpose of
documenting the basis for requested payments. Disclosure of this information is voluntary. However, failure to disclose the information will
make it impossible for Peace Corps to pay for these services. This information will be maintained under the provisions of HIPAA and under
the provision of the Privacy Act for routine uses described in the Federal Register of August 27, 1984 (relating to Peace Corps Volunteer
medical records).
For Peace Corps use only

To be completed by PCMORefer to Technical Guidelines
Medically cleared by PCMO for extension of service or transfer. No significant undiagnosed, unresolved,
or potentially recurrent health conditions.
Medically cleared or provisionally medically cleared by OMS for extension of service or transfer.
Consultation by PCMO with OMS is required for undiagnosed, unresolved, or potentially recurrent health
conditions.
Not medically cleared for extension of service or transfer due to significant unresolved or potentially
recurrent health conditions. Consultation by PCMO with OMS is required.
Revised April 2007
Page 4 of 4
TG 330 Attachment D
Peace Corps
Report of
Dental Evaluation
PC-1790 (Dental)
Sex M F
Name: (Last, First, Middle Initial)
Social Security number
Date of birth (MO / DAY / YR)
/
PEACE CORPS USE ONLY
Check one:
Pre-service dental exam

Post-service dental exam
Other (please specify)
Country of service
Date of exam (MO / DAY / YR)
Home/permanent address
Telephone No.
I. General Dental Evaluation

A. Chart existing restorations, missing teeth
and endodontically treated teeth:
Check here if no existing

restorations, missing teeth
or endodontically treated teeth
OR
Comment on findings:
B. Chart diseases, abnormalities and

all recommended treatment:
Check here if no disease, abnormality

or recommended treatment
OR
Comment on findings:
Page 1 of 4
Applicant SSN:
II. Periodontal Evaluation

A. Chart periodontal probings, gingival recession, and mobility
Buccal
Lingual
Buccal
Lingual
Lingual
Buccal
Lingual
Buccal
Calculus Deposits:
Light
Moderate
Heavy
B. Identify by number all teeth with:

Areas of bleeding upon probing
None
Affected teeth: ________________________________________
Areas of suppuration
None
Affected teeth: ________________________________________
Furcation involvement
None
Affected teeth: ________________________________________
Insufficient attached gingiva
None
Affected teeth: ________________________________________
C. Periodontal Classification:
No Disease
Class I: Gingivitis
Class II: Early Periodontitis
Class III: Moderate Periodontitis
Class IV: Advanced Periodontitis
D. Recommended periodontal therapy:
Page 2 of 4
Peace Corps Report of Dental Examination
Applicant SSN:
III. Third Molar Evaluation

No history of pericoronitis
History of pericoronitis
Please provide dates:
Third molar extraction not recommended

Third molar extraction recommended
Please specify recommended extractions:
IV. TMJ Evaluation

No history of TMD
History of TMD Symptoms
Please describe treatment provided, dates, and if symptoms are present at this time:
V. Bruxism
No history of bruxism
History of bruxism
Please describe any bruxism habit, presence of wear facets or need for occlusal guard:
VI. Prosthesis
No prosthesis present
Prosthesis present
Please describe the nature and extent of the prosthesis (e.g. full or partial dentures, bridge, etc.)
and the need for repair or replacement:
VII. Treatment
List all treatment completed after this examination. Do not include treatment planned but not yet completed.
Treatment
Date
Signature
Page 3 of 4
Applicant SSN:
* Important *
INCOMPLETE FORMS WILL BE RETURNED

AND MAY DELAY PROCESSING!
Dental examination is
complete only when:
The dentist has completed all sections

of the charting form.
2
3
The dentist has signed and dated the form.

The dentist has listed all treatment completed
in Section VII.
Dentists signature
Date
Dentists License number
State
Applicants only:
The dentist has included one of the
following sets of x-rays:
1) A full mouth series, or
2) A Panorex with bitewing x-rays.
Periapical or Panorex films must be
less than two years old.
Bitewing x-rays must be less than
one year old.
All films must be original films,
not duplicates.
Dentists name, address and phone number
Close-of-service only:
The dentist has included bitewing x-rays.
FOR PEACE CORPS USE ONLY

Office of Medical Services Dental Consultant Dental Clearance Notes and Recommendations
Dental Clearance Pending
Date
Reason for Pending:
Dental Clearance
Date
Dental Clearance with Restrictions
Date
Specify restrictions:
Page 4 of 4
PC-OMS-127C
Authorization for Payment of Medical/Dental Services

Service Level
(PCMO: SeeTG340)
For Additional services, dial 855-855-1961, option 1, and ask for
the extension listed below:
OMS PCMO
Pre-Service: Ext. 1500
In-Service trainees and Volunteers: medevac,
home leave, medical hold: Ext. 1500
Post-Service (after COS or ET): Ext: 1540
Expires 6 months after date of COS or ET
Name:
Last
First
Social Security #
COS/ET Date (dd-mon-yy)
Country of Service
Expiration Date (dd-mon-yy)
MI
This Authorization is Valid Only for the Services Identified Below

Provider:
Specialty:
Problems/Symptoms/HX:
Services Authorized:
Authorized by:
Date:
(dd-mon-yy)
Signature:
Important Information About Bill Payment

Please Note:
For reimbursement requests:
The Peace Corps uses a health benefits program fee schedule. The Peace
Corps does not pay fees in excess of this schedule. In using this
authorization, the provider and patient agree to accept the health benefits
program fee schedule as full payment for services. Providers may not bill
patients for any balance in excess of the fee schedule.
Applicants, in-service and post-service Volunteers,

Please enclose:
(1) A copy of this signed authorization (PC-OMS-127C).
(2) An itemized bill from your service provider and
(3) Proof that you have paid for services out-of-pocket, e.g., a
canceled check, provider receipt, or a credit card statement.
Questions about reimbursement should be directed to 800-544-1802
All claims should be submitted to:
For payment requests:

Service providers, please enclose:
(1) A copy of this signed authorization (PC-OMS-127C)
(2) A itemized bill on UB-92, HCFA-1500 or ADA claim form
Peace Corps Health Benefit Program

P.O. Box 3370
Carmel, IN 46082-3370
Claims Department fax number: 317-818-2087
Permission to Release Health Information
HIPAA and Privacy Act Notice:
The Peace Corps requires a copy of a summary report of evaluation or

treatment for your health record.
The information requested is collected under authority of the Peace

Corps Act, 22 U.S.C. 2501 et seq., for the purpose of documenting
the basis for requested payments. Disclosure of this information is
voluntary, but failure to do so will make it impossible for Peace
Corps to pay for these services. This information may be used for
the routine uses described in the Privacy Act, 5 U.S.C. 552a, and in
the Federal Register at 65 Fed. Reg. 53,722 (September 5, 2000)
and 50 Fed. Reg. 1950, 1962 (January 14, 1985) regarding the
Peace Corps system of records PC-17 (Volunteer records). It may
also be subject to the Health Insurance Portability and
Accountability Act (HIPAA).
PC-OMS-127C(10/2015)
I authorize the release of reports of the services authorized above to

the Peace Corps Office of Medical Services, as provided by HIPAA
and the Privacy Act.
Signature of Applicant, In-Service, or Post-Service Volunteer
Date
TG 330 ATTACHMENT F
AUTHORIZATION FOR VOLUNTEER MEDICAL EXAMINATION AND LABS

(PC-209B)
NOTES TO THE PCMO:
Issue this form with a PC-1790 (COS/EXT).

Complete the identifying information below.
Indicate all necessary COS labs in the chart below.
Inform the Volunteer that this form must be used within 60 days of issue.
Authorized by:
Volunteer Name:
(PCMO signature)
Date of Issue:
Volunteer SSN:
Country:
COS/ET Date:
VOID 60 DAYS AFTER ISSUE

NOTE TO EXAMINING PHYSICIAN: This letter authorizes you to give the returned Peace Corps Volunteer
identified above a full medical examination and perform the lab tests indicated below. The examination must
be documented on PC-1790 "Peace Corps Close-of-Service or Extension-of-Service Medical Examination."
The Volunteer will complete Section One of that form. Please use Section Two of that form to document the
clinical examination, lab results and summary comments. For questions on the PC-1790 or authorized tests
contact the Peace Corps Post-Service Unit at 800-424-8580, extension 1540. The following tests are
authorized:
Dipstick Urinalysis
Pap Smear Cytology
Hematocrit or Hemoglobin
Chlamydia Testing
G6PD Status
HIV Serology Type 1 and 2
TB Test/5 IU PPD
Stool for Occult Blood
Stool for Ova and Parasites (x3)
Mammogram
Shistosomiasis Serology
FEES FOR SERVICES: Peace Corps guarantees payment in accordance with its Health Benefits Program Fee
Schedule. Billing of Peace Corps Volunteers for any outstanding balance is not permitted under this plan. If
you have a question about the Health Benefits Program Fee Schedule please call1-800-544-1802.
CLAIMS PAYMENT INSTRUCTIONS:
The following items must be enclosed with your
claim:
1) This authorization form
2) A completed PC-1790 and lab results
3) An itemized bill. Please use UB-92,
HCFA-1500 or SF-1080.
Send your claim for reimbursement, together with

authorization, PC-1790, and bills to:
PO Box 3370
Indianapolis, IN 46082-3370
NOTE TO VOLUNTEER: You may pay for authorized services out-of-pocket and request reimbursement
from Peace Corps. To receive reimbursement you must mail the following items to the address shown above:
White - Provider Copy
Yellow - Health Record Copy
Pink - Patient Copy
TG 330 ATTACHMENT F
(1) this authorization form; (2) a completed PC-1790; (3) bills for lab fees and test results; and (4) proof of
payment (i.e., a canceled check or receipt).
PRIVACY ACT NOTICE: The information requested is collected under authority of the Peace Corps Act for the purpose of documenting the basis
for requested payments. Disclosure of this information is voluntary. However, failure to disclose the information will make it impossible for Peace
Corps to pay for these services. This information will be maintained under the provisions of the Privacy Act for the routine uses described in the
Federal Register of August 27, 1984 (relating to Peace Corps Volunteer medical records).
PC-209B (REV 8/2011)
White - Provider Copy
Yellow - Health Record Copy
Pink - Patient Copy
TG 330 ATTACHMENT G
INSTRUCTIONS FOR VOLUNTEERS

COS GUIDELINES FOR PREVENTING MALARIA
As you finish your Peace Corps service and return to the United States, it is imperative that you
continue taking anti-malarial prophylaxis. The type of anti-malaria medications(s) you must take
and the duration of time you must take the medication(s) depends on the species of malaria in
your country of service and the specific anti-malarial prophylaxis medication you are currently
taking (see tables below).
Since few Volunteers serving in malarial areas can escape mosquito bites and no prophylactic
drugs prevent infection with malaria, it is assumed that you are infected, or have been reinfected, with the malaria parasite. Fortunately, the anti-malarial medication you have been
taking during your tour has suppressed the parasites, thus preventing you from having any
signs or symptoms of malaria infection.
POST-DEPARTURE PROPHYLAXIS
Required For All Volunteers Serving in Malaria Endemic Areas
Continuing anti-malarial medication after your departure from a malarial endemic area (postdeparture prophylaxis) is necessary to eliminate the malaria parasite from your system. As long
as you remain or travel in a malarial area, you continue to be at risk of re-infection and the
medication will not eliminate the parasites from your system.
To eliminate these malaria species from your system, the parasite must have matured from the
liver stages (exoerythrocytic) into the blood stages (erythrocytic). Prophylactic drugs work most
effectively at the blood stages. Anti-malarials, such as chloroquine, mefloquine and
doxycycline, are effective against P. falciparum and P. malaria parasites in the blood stages.
Malarone is effective against P. falciparum parasites in both the blood and liver stages.
Maturation of P. falciparum from the liver stages to the blood stages takes approximately 28
days; this is why you must take chloroquine or mefloquine weekly for 4 weeks or
doxycycline daily for 4 weeks after leaving a malarial zone. Because Malarone acts against
the liver stages of P. falciparum, as well as the blood stages, the duration of taking this drug is
shorter; taking Malarone daily for 1 week is sufficient for post-departure prophylaxis.
POST-DEPARTURE PROPHYLAXIS PROCEDURE
ANTI-MALARIAL DRUG
DOSE
FREQUENCY
DURATION
Mefloquine
(1) 250 mg tablet
Weekly
4 weeks
Chloroquine
(1) 500 mg tablet
Weekly
4 weeks
Doxycycline
(1) 100 mg tablet
Daily
4 weeks
Malarone
(1) tablet
Daily
1 week
If you plan to travel in a malaria endemic area following COS, you must take with you enough
anti-malarial medication for the duration of your travels and for post-departure prophylaxis.
December 2013
Page 1
TG 330 ATTACHMENT G
PRESUMPTIVE ANTI-RELAPSE THEARPY (PART)

Required for All Volunteers Serving in Malaria-Endemic Areas
(Except for the Dominican Republic)
During Peace Corps service, you may also have been infected with other, less virulent species
of the malaria parasite, including P. ovale and P. vivax. These species may reside harmlessly
in your liver for months or years without causing any symptoms, but they can cause malaria
months or years later (called relapsing malaria). Special prophylaxis called presumptive antirelapse therapy is required to eliminate these species from your system. While the malaria
infection these species cause is not as serious as malaria caused by P. falciparum, it can be
very uncomfortable.
Primaquine phosphate is the specific drug used to eliminate P. ovale and P. vivax parasites
from your liver. You have been given 28 Primaquine phosphate 15 mg. tablets by your PCMO.
You should take two tablets daily for 14 days. If your post-departure prophylaxis is
chloroquine, mefloquine or doxycycline, you should start taking the tablets 2 weeks (Day 15)
following your departure from the malaria area. If your post-departure prophylaxis is Malarone,
you should start taking the tablets 1 week (Day 8) following your departure from the malaria
area.
PART PROCEDURE
POST-DEPARTURE
PROPHYLAXIS
WHEN TO START PRIMAQUINE (30 MG)

(Following Departure from a Malarial Endemic Area)
Mefloquine
Start on Day 15 (2 weeks following departure).
Chloroquine
Doxycycline
Malarone
Start on Day 8 (1 week following departure).
Before service you were tested for G6PD, an enzyme necessary to metabolize primaquine. If
your G6PD level is normal or adequate, your PCMO will give you primaquine and you may
commence terminal prophylaxis as outlined above. If your G6PD level is low or absent, you
should not take primaquine. You should contact your health care provider when you arrive
home. Individuals with low or absent G6PD levels should only take primaquine if
recommended, and supervised, by a medical professional.
Adverse effects of primaquine in individuals with normal levels of G6PD are infrequent.
However, if your urine becomes very dark or red while taking primaquine, stop taking the drug
and consult a physician. You may also contact the Peace Corps Office of Health Services at 1855-855-1961, extension 1540, option 7 for advice. Primaquine should not be taken during
pregnancy.
December 2013
Page 2
TG 330 ATTACHMENT H
REFUSAL OF VOLUNTARY COS HIV ANTIBODY TESTING
I,
am electing to leave Peace Corps without

(Volunteer Name)
having a blood specimen drawn at completion of service for human immunodeficiency virus
(HIV) antibody testing. I fully understand that this may jeopardize my benefits under the
Federal Employees Compensation Act and AfterCorps insurance should I later be found to
be infected with HIV.
(Volunteer Signature)
(Date)
Volunteer ID Number)
(Country of Service)
PCMO Printed Name:

PCMO Signature:
March 2014
TG 330 ATTACHMENT I
REFUSAL TO UNDERGO A COS HEALTH EVALUATION
I,
, am electing to leave Peace Corps without

(Volunteer Name)
having a Close of Service (COS) health evaluation. I fully understand that refusal of this
evaluation may adversely affect my eligibility for or coverage by post-service benefits,
including those under the Federal Employees Compensation Act, AfterCorps, and Peace
Corps-authorized post-service evaluations of service-related conditions.
(Volunteer Signature)
(Date)
-
(Volunteer SSN)
(Country of Service)
PCMO Printed Name:

PCMO Signature:
TG 330 ATTACHMENT J
Praziquantel (Biltricide)
(Schistosomiasis Medication)
Medication Information Sheet
What is praziquantel?
Praziquantel is a medication used to treat schistosomiasis (and infection with a type of worm
that lives in the bloodstream). It is a class of medication called anthelmintic which works by
killing the worms. Praziquantel is used for both treatment of individual patients and in mass
community treatment programs.
What is schistosomiasis?
Schistosomiasis, also known as bilharzias, is a disease caused by parasitic worms from the
Schistosoma genus. Schistosoma. mansoni, S. haematobium, S. japonicum, S. mekongi, and S.
intercalatum cause illness in humans. Different clinical complications are associated with the
various species. The clinical features also differ in acute and chronic infections.
Why should I take praziquantel?
You have been living in a Schistosoma endemic area. Any freshwater (lakes, rivers, streams,
even rainwater overflow) must be considered contaminated. It is almost impossible not to come
into contact with presumptively contaminated water during service. Long term kidney and bowel
complications can be severe in untreated infections. In order to avoid these complications,
Peace Corps policy is to treat all Volunteers who have lived in endemic areas as they COS.
How do I take the tablets?
The dose of praziquantel is based on weight and will be individualized for each Volunteer, then
divided in two. The two doses are taken in one day four to six hours apart. Take the tablets and
portion of tablets by water with a meal. Do not crush, chew or hold the tablets in your mouth. Do
not eat grapefruit or drink grapefruit juice while taking praziquantel.
Are there any side effects (adverse reactions)?
Adverse effects of praziquantel are generally mild, but occur in approximately one third of
people. Side effects include dizziness, malaise, headache, vomiting, abdominal pain diarrhea
and itching. These symptoms may be partly related to the drug itself and may be partly related
to host immune responses to dying worms. Call the PCMO (or your doctor) if they become
severe or do not go away, or if you develop hives.
Praziquantel may make you drowsy. Do not drive a car or operate machinery on the day you
take praziquantel and the day after you take it.
What special precautions should be followed?
Before taking praziquantel,
Tell your PCMO if you are allergic to praziquantel or any other medications
Page 1
December 2013
TG 330 ATTACHMENT J
Tell your PCMO all medication (prescription or nonprescription), vitamins, nutritional

supplements and herbal products you are taking or plan to take. Other medications can
interact with so it is important to mention every medication you are taking, especially
rifampin, malaria medications, cimetadine, dexamethasone, erythromycin, itraxonazol,
ketaconazole or seizure medications. Your PCMO may need to change doses of your
medication or monitor you closely for side effects.
Tell your PCMO if you have or have ever had seizures, cysticercosis nodules (bumps)
just under your skin; or kidney, liver or heart disease.
Tell your PCMO if you are pregnant or plan to become pregnant.
What should I do if I miss my second dose?

Take your second dose as soon as you remember with a meal or food. To avoid forgetting, set a
reminder on your phone.
How do I store praziquantel?
Store at room temperature in a dry place. Keep all drugs out of reach of children and pets.
Page 2
December 2013
TG 330 ATTACHMENT K
Primaquine Phosphate
(Anti-Malarial Medication)
Medication Information Sheet
What is primaquine phosphate?
I t is one of sev eral types of drugs used to prevent and treat malaria.
Primaquine phosphate is the specific drug used to eliminate P. ovale and P. vivax
parasites from your liv er. These species may reside harmlessly in your liv er for
months or years w ithout causing any symptoms, but they can cause malaria
months or years later (called relapsing malaria). Special treatment called
Presumptive Anti-Relapse Therapy (PART), formerly known as terminal
prophylaxis, is required to eliminate these parasites from your system. While the
malaria infection these species cause is not as serious as malaria caused by P.
falciparum, it can be v ery uncomfortable.
How do I take the tablets?
You hav e been giv en 28 tablets (15 mg) by your prov ider
Take tw o (2) tablets by mouth daily for 14 days
I t may be taken w ith food if stomach upset occurs, but not w ith antacids
For best results, take each dose at the same time ev ery day. This w ill
ensure a constant lev el of medication in your blood
Take this medication for the full time prescribed. Stopping therapy too
soon may result in a re-infection
Store at room temperature aw ay from sunlight and moisture
Do not share medications w ith others
PART
POST-DEPARTURE PROPHYLAXIS
Mefloquine
Chloroquine
Doxycycline
Malarone
WHEN TO START PRIMAQUINE (30 MG)

(Following Departure from a Malarial
Endemic Area)
Start on Day 15 (2 w eeks follow ing
departure)
departure)
departure)
Start on Day 8 (1 w eek follow ing
departure)
12/2013
Are there any side effects (adverse reactions)?
You may hav e an upset stomach, stomach cramps, nausea, v omiting, loss
of appetite, or muscle w eakness, especially during the first several days as
you body adjusts to the medication. I f any of these symptoms persists or
become sev ere, inform your health provider.
Notify your health prov ider if you dev elop a rash, rapid heart rate,
changes in v ision, hearing trouble, ringing in the ears, or dark urine w hile
taking this medication.
Is there any reason I should not take primaquine phosphate?
I f your G6PD lev el is low or absent, you should NOT take primaquine.
I f your G6PD is low or absent, consult w ith your health care provider when
you arriv e home.
I ndividuals with low or absent G6PD levels should only take primaquine if
recommended, and supervised, by a medical professional
I f you hav e arthritis, psoriasis, lupus, liver disease or allergies to primaquine
I f you are pregnant or breast-feeding. Discuss the risks and benefits with
your Peace Corps health prov ider while in country or your health care
prov ider at home. The CDC recommends postponing primaquine until
after deliv ery or breast feeding (unless the infant has been tested for
G6PD deficiency).
What should I do if I miss a dose?
I f you miss one or more doses for any reason, take ONE dose as soon as
possible and then continue on your usual dosing schedule. DO NOT
double-up the dose to catch up unless instructed to by a health care
prov ider.
What should I do if I overdose?
I f ov erdose is suspected, contact the American Association of Poison

Control Centers (1-800-222-1222), your health prov ider or an emergency
room immediately. Taking more than one dose can cause serious
adv erse effects.
12/2013
TG 330 ATTACHMENT L
Post-Service Health Benefits at Glance

AfterCorps
Benefit Covers:
Non-Service related medical problems. Specifically:
1. Most pre-existing conditions not covered by FECA.
2. Conditions that arose during service that are not covered by FECA, e.g. while in the U.S. on vacation,
home leave, emergency leave, or medevac.
3. Health problems that arose after Volunteer service.
Time Limit:
Peace Corps pays one month's premium for all Volunteers. Volunteers may purchase up to 2 months of
additional coverage for themselves, their spouse, and all qualified dependents (younger than 18 years
old) while transitioning into private insurance (Affordable Care Act - www.healthcare.gov or parents plan).
How Accessed:
Contact AfterCorps Customer Service for:
1. Emergency medical assistance
2. Referrals to Multiplan hospitals, physicians, and other health services
3. Insurance coverage extensions
To extend or confirm coverage, preauthorize emergency and non-emergency medical treatment, inquire
about the status of your medical claim or find a US network provider call 800-690-6295 or 317-818-2809
(collect calls accepted).
Additional information can be found at:
http://www.peacecorps.gov/resources/returned/benefits/healthben/aftercorps/
PC-127c Authorization
Benefit Covers:
Authorizes payment for evaluation of medical and dental health conditions related to Volunteer service
Time Limit:
Must be issued and used within six months after service.
How Accessed:
May be issued by Peace Corps Medical Officers (PCMO) or the Peace Corps Office of Health Services
(OHS) Post-Service Unit
Call 855-855-1961, ext. 1540, option 7 or e-mail psu@peacecorps.gov
http://www.peacecorps.gov/resources/returned/benefits/healthben/medical/
FECA
Benefit Covers:
Treatment for most medical and dental conditions related to Volunteer service and conditions incurred or
contracted while overseas during service
Time Limit:
Claims must be filed within three years after service, or within three years of recognition that a health
How Accessed:
Claims should be filed through the OHS Post-Service Unit. Call 855-855-1961, ext. 1540, option 7 or
202-692-1540, option 7, or e-mail psu@peacecorps.gov
http://www.peacecorps.gov/resources/returned/benefits/healthben/feca/
February 2014
Peace Corps
PC-127C FORM AUTHORIZATION FOR

PAYMENT OF MEDICAL/DENTAL SERVICES
1. PURPOSE
To provide instructions on the use of form PC-127C Authorization for Payment of

Medical/Dental Services (ATTACHMENT A).
To provide instructions on the use of the Health Benefits Program identification card
(ATTACHMENT B).
2. BACKGROUND
Form PC-127C (127C) authorizes payment of medical and dental services. The 127C is
designed for use in the U.S. For information on the use of the 127C outside of the U.S., see
Section 5 below.
Peace Corps utilizes a Health Benefits Program fee schedule. Peace Corps does not pay fees
in excess of this schedule and providers who accept the 127C have agreed to accept the Peace
Corps Health Benefits fee schedule as full payment for services. Providers may not bill
Volunteers for any fees in excess of the fee schedule. Volunteers are not expected to pay copayments charged by providers. The Health Benefits identification card is designed to
facilitate access to care and payment for services.
3. USE OF THE PC-127C FORM
A 127C authorization should be used in conjunction with a Peace Corps Health Benefits
identification card (see section 6 below).
A 127C must be signed by both the Peace Corps medical staff member authorizing
service and the Volunteer seeking care. The staff member signature authorizes payment
of services and the Volunteer signature authorizes the release of medical and dental
reports to the Office of Medical Services (OMS) for the services associated with the
127C.
The 127C form has three parts. The original (health record copy) is placed in the
Volunteers health record under In-Service or Close of Service (COS)/Post-Service
care depending on when it was issued. The first copy (provider copy) is given to the
provider by the Volunteer and the second copy (patient copy) is for the Volunteer's
personal records. The Peace Corps Medical Officer (PCMO) should ensure that all three
copies are legible prior to issue.
A 127C may be issued by a PCMO, Area Peace Corps Medical Officer (APCMO), or
OMS staff.
Office of Medical Services
September 2008
Page 1
TG 340
PC-127C Form
A separate 127C authorization should be issued for each provider. A single authorization,
however, may request that one provider evaluate several conditions.
If a Volunteer has multiple conditions that require specialist evaluation, care should be
coordinated through a primary care physician (family practitioner or internist).
The 127C should be issued for an initial evaluation, to include diagnosis and management
recommendations, of the conditions. A 127C form may be used during service and at
COS (see sections 3.1 and 3.2 below).
USE OF THE PC-127C
During Service
At Close of
Service
After COS
Issued by PCMO
Issued by OMS
Contact Field Support Unit for

medical or dental evaluation and
treatment for Volunteers traveling to
the U.S.* on vacation, home leave or
emergency leave. (PCMOs in AF
Region should coordinate with
APCMO before contacting the Field
Support Unit.)
Evaluation of medical or dental
conditions related to Peace Corps
overseas service.
Field Support: Evaluation and

treatment of medical and dental
conditions for Volunteers in the U.S.
on medevac, medical hold, or on
vacation, home leave, or
emergency leave with an
unanticipated illness or injury.
Refer Volunteer to the OMS Post

Service Unit.
Post Service: Within 180 days after

COS, OMS authorizes evaluation of
medical or dental conditions related
to Peace Corps overseas service
Field Support: Evaluation of

medical or dental conditions related
to overseas service for Volunteers
who close service from a location
other than their country of service.
(Most commonly, this applies to
Volunteers who are medically
separated or resign following a
medevac.
* For use of the PC-127C outside the U.S.; see section 5 below.
3.1
During Service
3.2
PCMO will contact the Field Support Unit in OMS when Trainees and Volunteers
require evaluation and/or treatment for medical or dental conditions while they are
traveling to the U.S. 1 on home leave, emergency leave, or vacation. PCMOs in the
Africa Region should coordinate medical and dental care with APCMO before
contacting the Field Support Unit.
At Close of Service
At COS 127Cs should be issued to Volunteers who require:
1 For information on the use of the 127C outside the U.S.; see section 5 below.
September 2008
Page 2
TG 340
PC-127C Form
1. Evaluation of ongoing, unresolved medical and dental problems;

2. Dental examination as per Technical Guideline (TG) 180 Dental Policy;
3. Specific laboratory tests which were not accomplished prior to COS, or are not
available in-country, e.g., stools for ova and parasites, mammography, etc.
4. Readjustment support counseling (three one hour sessions only).
5. At COS, 127Cs should be issued for evaluation only. Only the specific
evaluation authorized will be reimbursed. A 127C cannot be used for medical
treatment, with two exceptions; First, it can be used to authorize a single course
of treatment for parasites. In these cases the authorization should read as
follows:
Initial office visit and one follow-up. One course of treatment. Follow-up stool
exams for O & P x 3 post treatment. No further treatment authorized.
Second, it can be used to authorize a treatment for terminal malaria prophylaxis.

In these cases the authorization should read as follows
Primary care consultation for G6PD testing and terminal malaria
prophylaxis as indicated
127Cs issued at COS should be issued for physicians, clinical psychologists, and
dentists only, i.e., Department of Labor (DOL) criteria of an authorized provider. A
127C may be issued at COS for other types of licensed healthcare providers;
however, if the medical problem results in a Federal Employees Compensation Act
(FECA) claim the evaluation will not be accepted by DOL and the Volunteer will
be required to obtain additional evaluation.
4. INFORMATION FOR THE VOLUNTEER USING A 127C
The Volunteer must have a 127C authorization prior to receiving medical or dental
evaluation or treatment.
For questions regarding 127C authorizations, FECA benefits, or other service-related

health issues, returned Volunteers should contact the OMS Post-Service Unit at 800-4248580 (extension 1500) or 202-692-1500.
The Volunteer should use the 127C authorization with his/her Health Benefits Program
identification card.
For questions regarding the use of the Health Benefits identification card, Volunteers
should contact the Peace Corps Health Benefits Program at 1-800-544-1802. For
information on network providers in a particular geographic location, Volunteers should
contact Health Systems International (HSI) at 800-726-0766. Numbers are listed on the
Health Benefits identification card and the Instructions for Use information sheet.
September 2008
Page 3
TG 340
PC-127C Form
4.1
4.2
During Service
The International Health Coordinator(IHC) in the Field Support Unit will issue
127C for Volunteers requiring a medical or dental evaluation/treatment while they
are in the U.S.
The Volunteer is responsible for obtaining medical reports from his/her providers
and communicating medical information to the IHC. The Volunteer will also bring
a copy of the reports to post for inclusion in his/her health record.
The Volunteer must contact OMS if a new health problem develops or a previous
health problem becomes unstable while he/she is in the U.S. Evaluation and
treatment of illnesses or injuries that develop while a Volunteer is in the U.S. are
authorized and managed by OMS.
If the nature of the illness prevents the Volunteer from returning to country as
scheduled, OMS may place the Volunteer on medical hold status (see TG 370
Field Consultation section 13.3 Medical Hold) pending the outcome of the
evaluation and treatment.
At Close of Service
Emphasize to the Volunteer that a 127C covers evaluation only, not treatment.
A 127C must be used within six months of the Volunteers COS date. It will not be
honored after that time has elapsed.
If, following an authorized evaluation, additional evaluation is necessary, the

Volunteer must contact the OMS Post-Service Unit.
If, following an authorized evaluation, treatment is necessary, the Volunteer must

contact the OMS Post-Service Unit for information on benefits under FECA. The
Post-Service Unit assists former Volunteers in filing claims for treatment with the
Department of Labor under FECA.
After COS, a Volunteer with questions or problems with his/her 127C authorization
should contact the Post-Service Unit in OMS.
Advise the Volunteer to retain a copy of the 127C for his/her records.
5. USE OF THE 127C OUTSIDE THE UNITED STATES
Obtaining routine health care outside the U.S. using a 127C is not encouraged. When
necessary, a 127C may be issued to a Volunteer for use outside of the U.S.
The Volunteer should be informed that providers in countries other than the U.S. may not
accept the 127C form. In these cases, the Volunteer will be required to pay for services at
the time of the visit and seek reimbursement from the Peace Corps Health Benefits
Program in a timely manner. The procedures for reimbursement are clearly outlined on
the 127C form.
September 2008
Page 4
TG 340
PC-127C Form
During service and after COS, all 127Cs issued by post and used outside the U.S. should
be submitted to the Peace Corps Health Benefits Program for reimbursement (see section
7 below).
The Volunteer should be informed that he/she is responsible for obtaining all medical
reports for care received outside the U.S. During service, these reports should be brought
to post to be included in the Volunteers health record. For services received after COS, a
copy of all reports should be retained by the Volunteer as this information may be needed
to facilitate payment by the Health Benefits Program or to document eligibility for postservice health benefits.
6. PEACE CORPS HEALTH BENEFITS PROGRAM IDENTIFICATION CARD

A Health Benefits identification card is issued in the medical record of all new Trainees. The
card and an Instructions for Use sheet are located on the left hand side of the medical
record on top of the blue COS/Post-Service divider. A sample card and instruction sheet are
included in ATTACHMENT B.
The purpose of the Health Benefits identification card is to:
Provide the Volunteer or Returned Peace Corps Volunteer (RPCV) with access to
a network of medical providers in the U.S. willing to accept the 127C and/or the
PC-209B Authorization for Medical Examination and Labs form (see TG 330
Post-Service Health Benefits and Close of Service or Extension of Service
Health Evaluations section 4.5, for information on the use of the 209B form).
Facilitate proper and timely payment of medical bills associated with medical and
dental services authorized on the 127C and 209B.
The Health Benefits identification card should be presented along with the 127C or 209B
whenever the Volunteer or RPCV seeks to access medical care in the U.S. Use of the
Health Benefits identification card in this manner will:
Ensure that the provider agrees to accept the Peace Corps Health Benefits
Program fee schedule as full payment for services;
Protect the Volunteer from having to pay for care at the time of service;
Protect the Volunteer from being billed directly by the provider for full or partial
payment of services, or for fees in excess of the fee schedule.
The Health Benefits identification card must only be used with a 127C or 209B
authorization. Use of the health benefit card without a 127C or 209B does not authorize
payment of medical services. Volunteers or RPCVs who obtain medical services in the
U.S. without a 127C or 209B authorization may not be reimbursed by Peace Corps.
Because Volunteers and RPCVs should present the Health Benefits identification card
whenever medical services are sought using a 127C or 209B, Volunteers must have the
card in their possession whenever they travel to the U.S., regardless of the reason, e.g.,
vacation, home leave, emergency leave, medevac, etc., and at COS.
September 2008
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TG 340
PC-127C Form
At post, the PCMO is responsible for issuing the Health Benefits identification card and
ensuring that Volunteers understand its use.
The PCMO, and the post administrative staff, are responsible for ensuring that Volunteers
have their cards whenever a 127C or 209B is issued and when travel to the U.S. is
planned. Therefore, posts should treat the card like other important travel documents and
store the card with the Volunteers passport or in the Volunteers health record. In certain
circumstances, post may require Volunteers to be responsible for their own cards.
Volunteers and RPCVs may use a provider of their choice; however, in light of the
benefits outlined above, the OMS Health Benefits Program strongly encourages
Volunteers to use providers who are members of the network. For information on
network providers in a particular geographic location in the U.S., Volunteers should
contact HSI at 800-726-0766 or on the web at www.peacecorps.sevencorners.com.
The Health Benefits card is valid during Peace Corps service and up to the expiration
date on an accompanying 127C or 209B authorization.
The Health Benefits identification card is separate and distinct from the CorpsCare PostService health insurance program and the CorpsCare insurance card.
7. PAYMENT AND REIMBURSEMENT OF CARE AUTHORIZED BY A 127C
Peace Corps utilizes a Health Benefits Program fee schedule that is consistent with
recognized fee schedules used by health care insurers in the U.S. Providers who accept
the 127C form agree to accept the Peace Corps Health Benefits Program fee schedule as
full payment for services (see information highlighted in red on the 127C form). Peace
Corps does not pay charges in excess of this schedule.
The standard method of payment of medical or dental care authorized by a 127C is for
the provider to accept the 127C, with the Health Benefits identification card, and to
submit a claim directly to the Peace Corps Health Benefit Program.
In the event that a Volunteer cannot locate a provider who will accept the 127C form, the
Volunteer may pay for the medical care at the time of service and submit a claim for
reimbursement to the Peace Corps Health Benefits Program. In most cases, the Volunteer
will be reimbursed according to the Peace Corps Health Benefits Program fee schedule.
Information, including all necessary documentation required for submitting a claim, is

highlighted in red bold type in the center of the 127C.
All 127C authorizations should be submitted to the Peace Corps Health Benefits Program
for payment or reimbursement. This includes 127Cs issued by post or by OMS, 127Cs
issued for use in the U.S. or overseas, and 127Cs issued for use during service or after
COS.
Prior to receiving care, the Volunteer should read and understand the information on the
127C, including the specific services authorized and bill payment information.
September 2008
Page 6
TG 340
PC-127C Form
8. AUTHORIZING SERVICES
The specific services authorized must be clearly described in the section Services
Authorized on the 127C. Common examples include the following:
During Service
Evaluation by a Specialist
Dermatologist
Problems/Sx/Hx:
Irregular .3 cm. nevus on right cheek. Increasing in size x 2

months.
Evaluation and treatment of nevus on right cheek.
At COS
Evaluation of Multiple Conditions

Primary Care Physician
Problems/Sx/Hx:
1) Fungus R great toenail x 8 months.

2) Soreness in R knee; tx w/ ibuprofen; ho R knee injury
3) ASCUS Pap smear; report attached.
Evaluation of: 1) Fungus R great toenail; 2) Knee pain;

3) ASCUS Pap smear. Please provide diagnosis and treatment
plan. No treatment is authorized. If treatment is indicated
Volunteer should contact the Peace Corps Post-Service Unit for
assistance.
Evaluation by a Specialist
Dermatologist
Problems/Sx/Hx:
Chronic fungal disease on left arm x 15 months; treated w/

X,Y, and Z; Volunteer lived in desert climate.
Evaluation of papules on left upper arm. No treatment is

authorized. If treatment is indicated Volunteer should contact
the Peace Corps Post-Service Unit for assistance.
September 2008
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TG 340
PC-127C Form
Evaluation and Single Course Treatment of Parasites

Primary Care Physician
Problems/Sx/Hx:
History of amebiasis sp treatment w/flagyl; diarrhea

unresolved.
Initial evaluation of diarrhea and one follow-up. One course of

treatment. Follow-up stool exams for O & P x 3 post treatment.
No further treatment authorized. If further treatment is
indicated Volunteer should contact the Peace Corps PostService Unit for assistance.
Evaluation by a Dentist
Dentist
Problems/Sx/Hx:
Pain in left lower molar. Sensitive to cold.
For dental examination and routine prophylaxis only (including

bite-wing x-rays and other views as indicated). Record the
examination on PC-1790 (Dental) attached. If dental treatment
is indicated please describe in detail and estimate cost. No
treatment is authorized at this time.
Evaluation and Readjustment Support Counseling

Psychiatrist/Clinical Psychologist
Problems/Sx/Hx:
Volunteer completed two years of service as an agriculture

worker in Zaire, Africa.
Evaluation and three one hour sessions for readjustment
support. Provide diagnosis and treatment plan. No further
treatment authorized. If further treatment is indicated Volunteer
should contact the Peace Corps Post-Service Unit for
assistance.
9. COMPLETING THE FORM

The PCMO must complete every section of the 127C. If the name of the provider is not
known at the time of authorization, this line only may be left blank.
Volunteer Name / SSN / Country / COS or ET Date / Expiration Date

This section must be completed for billing and medical records purposes. When
completing a 127C for a Volunteer dependent list the Volunteers name and SSN
followed by the dependents name and SSN. The dependent must be clearly identified.
September 2008
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TG 340
PC-127C Form
Service Level
Mark an X in the appropriate box. For Volunteers going to the U.S. on vacation, home
leave, or emergency leave, mark In-Service.
Provider
Print name of provider if known.
Specialty
Designate Primary Care Physician, Dentist or type of specialist.
Describe problems, symptoms, history

Provide as much information as possible (see examples above). Attach copies of consult
reports, laboratory results, chart notes, and x-rays that may be helpful.
Describe services authorized

Indicate specific services authorized (see examples above).
Authorized By, Date, Signature of person authorizing service

PCMO prints, dates and signs name.

The Volunteer must read and sign this section, which allows medical information to be
released to Peace Corps.
September 2008
Page 9
PC-OMS-127C
Authorization for Payment of Medical/Dental Services

Service Level
(PCMO: SeeTG340)
For Additional services, dial 800-424-8580 and ask for the
extension listed below:
OMS PCMO
Pre-Service: Ext. 1500
*PCSTART127C*
In-Service trainees and Volunteers: medevac,

home leave, medical hold: Ext. 1500
Post-Service (after COS or ET): Ext: 1540
Expires 6 months after date of COS or ET
Name:
Last
First
Social Security #
COS/ET Date (dd-mon-yy)
Country of Service
Expiration Date (dd-mon-yy)
MI
This Authorization is Valid Only for the Services Identified Below

Provider:
Specialty:
Problems/Symptoms/HX:
Authorized by:
Date:
(dd-mon-yy)
*PCEND127C*
Signature:
Important Information About Bill Payment

Please Note:
For reimbursement requests:
The Peace Corps uses a health benefits program fee schedule. The Peace
Corps does not pay fees in excess of this schedule. In using this
authorization, the provider and patient agree to accept the health benefits
program fee schedule as full payment for services. Providers may not bill
patients for any balance in excess of the fee schedule.
Applicants, in-service and post-service Volunteers,

Please enclose:
(1) A copy of this signed authorization (PC-OMS-127C).
(2) An itemized bill from your service provider and
(3) Proof that you have paid for services out-of-pocket, e.g., a
canceled check, provider receipt, or a credit card statement.
Questions about reimbursement should be directed to 800-544-1802

For payment requests:
Service providers, please enclose:
(1) A copy of this signed authorization (PC-OMS-127C)
(2) A itemized bill on UB-92, HCFA-1500 or ADA claim form
All claims should be submitted to:

P.O. Box 3370
Carmel, IN 46082-3370
HIPAA and Privacy Act Notice:
The Peace Corps requires a copy of a summary report of evaluation or

treatment for your health record.
The information requested is collected under authority of the Peace

Corps Act, 22 U.S.C. 2501 et seq., for the purpose of documenting
the basis for requested payments. Disclosure of this information is
voluntary, but failure to do so will make it impossible for Peace
Corps to pay for these services. This information may be used for
the routine uses described in the Privacy Act, 5 U.S.C. 552a, and in
the Federal Register at 65 Fed. Reg. 53,722 (September 5, 2000)
and 50 Fed. Reg. 1950, 1962 (January 14, 1985) regarding the
Peace Corps system of records PC-17 (Volunteer records). It may
also be subject to the Health Insurance Portability and
Accountability Act (HIPAA).
PC-OMS-127C(03/2006)
I authorize the release of reports of the services authorized above to

the Peace Corps Office of Medical Services, as provided by HIPAA
and the Privacy Act.
Signature of Applicant, In-Service, or Post-Service Volunteer
Date
Instructions for Use

HEALTH BENEFITS PROGRAM IDENTIFICATION CARD
PCMO INSTRUCTIONS: To ensure Volunteers understand the Health Benefits Program identification card and its proper use, please
verify that the Volunteer has reviewed the information below. Have the Volunteer sign for receipt of the card, and leave the signature in
the medical records.
I have read the instructions below and understand the use of my Health Benefits identification card.
Received by: Volunteer Name:

Signature:
Date:
HEALTH BENEFITS PROGRAM

*FOR PAYMENT, MEMBER MUST PRESENT AUTHORIZATION
FROM PC-127C OR PC-209B WITH THIS CARD
MEMBER:
PEACE CORPS ID#
Administered by: Seven Corners, Inc.
DATE ISSUED
http://peacecorps.sevencorners.com
YOUR HEALTH BENEFITS PLAN IDENTIFICATION CARD

The purpose of your Health Benefits identification card is to:

Provide you access to a network of medical/dental providers in the United States willing to accept a PC-127C Authorization
for Payment of Medical/Dental Services and/or a PC-209B Authorization for Volunteer Medical Evaluation and Labs form.
Facilitate proper and timely payment of medical bills associated with the medical services authorized on your PC-127C form
and/or your PC-209B form.
The Health Benefits identification card must only be used with a PC-127C or a PC-209B authorization. Volunteers or RPCVs
who obtain medical services in the US without a PC-127C or PC-209B may not be reimbursed by Peace Corps.
The card is valid during your Peace Corps service and up to the expiration date on your accompanying PC-127C or PC-209B
authorization form.
Present the Health Benefits identification card anytime you seek medical services using a PC-127C or PC-209B authorization
form.
Have the card on your person when traveling to the United States for any reason, e.g.,vacation, home leave, emergency leave,
medevac, and at Close of Service (COS)
You may use a provider of choice, however, in light of the benefits outlined above, the Peace Corps Health Benefits Program
strongly encourages you to use providers who are members of the network to avoid out of pocket expenses.
For information on Medical or Dental network providers in a particular geographic location in the U.S., you should contact
Equian at 1(800)726-0766 or on the website http://peacecorps.sevencorners.com.
The Health Benefits identification card is separate and distinct from the AfterCorps medical insurance program and the AfterCorps insurance card that is provided to you at COS.
Rev PC (04/14)
HEALTH BENEFITS PROGRAM IDENTIFICATION CARD

IMPORTANT INFORMATION ABOUT YOUR BENEFITS
This health care plan requires authorization from Peace Corps for medical, mental health and dental services. A signed PC127C or PC-209B form indicates authorization. Member must present this ID card and signed authorization form at time of
service.
FIND A NETWORK PROVIDER IN YOUR AREA CALL: 1.800.726.0766 or on the web at: http://peacecorps.sevencorners.com
CUSTOMER SERVICE: 1.800.544.1802 http://peacecorps.sevencorners.com
CLAIMS MAILING ADDRESS: All claims must be submitted with a Peace Corps PC-127C or PC-209B authorization form to:
Peace Corps Health Benefits Attn: Claims PO BOX 3370 Carmel, IN 46082-3370
IMPORTANT INFORMATION ABOUT YOUR BENEFITS

This health care plan requires authorization from Peace Corps for
medical, mental health and dental services. A signed PC-127C or PC209B form indicates authorization. Member must present this ID card
and signed authorization form at time of service.
TO FIND A NETWORK PROVIDER IN
YOUR AREA CALL:
1-800-726-0766
or on the web at:
www.peacecorps.sevencorners.com
CUSTOMER SERVICE:
1-800-544-1802
www.peacecorps.sevencorners.com
CLAIMS MAILING ADDRESS:

All claims must be submitted with a
Peace Corps PC-127C or
PC-209B authorization form to:
Peace Corps
Attn: Claims
P.O. Box 3370
Carmel, IN 46082-3370
April 2014
Rev PC (04/14)
Peace Corps
BREAST IMAGING AND THE EVALUATION OF BREAST MASSES
1. PURPOSE
To provide guidance on breast imaging and the evaluation of breast masses.
2. BACKGROUND
A mammogram is an x-ray picture of the breast. Screening mammograms are used to check
for breast cancer in women who have no signs or symptoms of the disease. Diagnostic
mammograms are used to check for breast cancer after a lump or other sign or symptom of
the disease has been found. A sonogram, also called an ultrasound, is a computerized picture
taken using sound waves.
3. SCREENING GUIDELINES
Several organizations have published recommendations for screening mammograms. Peace
Corps follow the recommendations of the U.S. Preventive Services Task Force (USPSTF) as
they are the US government agency charged with creating such guidelines. These guidelines
can be found at:
http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm
A summary of the 2009 USPSTF recommendations for screening mammography are as
follows:
Women aged 50 to 74 should receive screening mammography for breast cancer
every two years.
The decision to start regular, biennial screening mammography before the age of 50
years should be an individual one and take patient context into account, including the
patient's values regarding specific benefits and harms.
There is insufficient evidence to assess the benefits and harms of screening
mammography in women 75 years or older.
Routine annual mammograms are not recommended by the USPSTF, but the decision to
perform mammography is individual and should take patient context into account, including
the patient's values regarding specific benefits and harms.
Screening mammograms performed in-country may be sent to OHS for review by a U.S.
radiologist according to the procedures outlined in section 9 below. Any mammogram
reported through the Breast Imaging-Reporting and Data System (BI-RADS) as BI-RADS
Category 3, must be sent to OHS for a second read by a US radiologist.
A field consultation must always be obtained for the evaluation of an abnormal breast
finding, e.g., breast mass, nipple discharge, and skin changes. ATTACHMENT A is a
standard Mammogram Field Consult form. The PCMO, together with OHS/RMO, is
June 2013
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TG 355
Mammography
responsible for the evaluation, monitoring, and follow-up of women with any abnormal
breast findings.
4. DIAGNOSTIC MAMMOGRAPHY
Mammography is of limited usefulness in women under age 40 due to higher breast tissue
density. Ultrasound is preferred to evaluate breast lesions in younger women. Mammography
should only be performed in a woman younger than 40 if indicated by her particular
circumstances.
A diagnostic mammogram, in a woman older than 40 years, is indicated in women with the
following conditions:
Signs or symptoms of breast disease including, but not limited to, mass, induration, axillary
lymphadenopathy, some types of nipple discharge, skin changes, or persistent focal areas of pain
or tenderness.
Abnormal screening mammogram.
Follow up of previous mammogram with BI-RADS Category 3 Probably Benign Finding.
Asymptomatic women who have breast implants or who have a history of treatment for breast
cancer may have a screening mammogram, instead of diagnostic mammogram, at the discretion
of the mammography facility 1.
Diagnostic mammograms performed in-country may be sent to OHS for review by a U.S.
radiologist according to the procedures outlined in section 9 below. All mammograms reported
as BI-RADS 3 must be sent to OHS for a second read by a US radiologist.
A negative diagnostic mammogram does not rule out malignancy in the presence of a palpable
mass or other breast abnormality. The purpose of mammography in this setting is to further
define the mass and to rule out the presence of an unexpected nonpalpable breast cancer in the
ipsilateral or contralateral breast. PCMOs should ensure that a Volunteer with a palpable breast
mass understands the purpose of mammography.
5. MAMMOGRAPHY ACCOMMODATION
As of August 2012, screening mammography is required for women age 50 and over
prior to entering Peace Corps service.
All female applicants who will be 50 years or older during their service are offered an
accommodation to a country where screening mammography is available. They may
choose to waive this accommodation, however, if certain risk factors are present, the
applicant will be assigned to a country with access to mammography.
If an applicant has waived the mammogram accommodation, Peace Corps will not
medevac her for screening mammography or issue a PC-127C for screening
mammography in the US or another country. However, if a PCV who had waived the
American College of Radiology. ACR Practice Guideline for the Performance of Screening
and Diagnostic Mammography. 2008.
http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Screening_Mammography.pdf
June 2013
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TG 355
Mammography
mammography accommodation has an indication for diagnostic mammography (see

Section 4 above), Peace Corps will arrange for access to this imaging.
All applicants are asked to obtain, and bring to country, copies of their most recent
mammogram(s). If, for any reason, a Volunteer arrives in country without her films, the
Peace Corps Medical Officers (PCMOs) should work with the Volunteer to obtain the
films and have them sent to post.
6. MAMMOGRAPHY FACILITIES OVERSEAS

Mammography facilities in the U.S. must be certified by the Food and Drug Administration
(FDA). OHS strongly prefers the use of U.S. facilities or facilities that approximate this
standard.
6.1 Evaluating Local Mammography Facilities
The PCMO, together with OHS, is responsible for determining the adequacy of
mammogram facilities and services overseas. Although it may not be possible to obtain
or judge information related to many of the components of the mammographic unit,
when inspecting facilities, PCMOs should consider the following:
Reporting; must be consistent with the BI-RADS system promoted by the

American College of Radiology (see Section 8).
Qualifications and Experience of the Interpreting Physician (Radiologist); to

include licenses, certifications, formal education, specialized training,
continuing medical education, and volume of procedures.
Qualifications and Experience of the Radiology Technologist; to include

licenses, certifications, formal education, specialized training, continuing
medical education, and volume of procedures.
Examination and Imaging Techniques of the Radiology Technologist; to include

patient preparation; awareness of patient's physical safety, comfort, and
sensitivities; radiographic technique to include proper positioning, breast
compression, penetration and familiarity with standard screening and diagnostic
views (mediolateral oblique, craniocaudal, and, for women with implants,
eklund views).
Description and Technical Specifications of Mammography Equipment; to

include x-ray equipment, image receptors (film), film processors, and filmviewing equipment (view box).
Operating Condition and Maintenance Protocols for Mammography

Equipment; to include x-ray equipment, image receptors (film), film processors,
and film-viewing equipment (view box).
Quality Control Practices; to include annual evaluation of equipment by a

qualified medical physicist, quality control of the radiology technologists
techniques regarding positioning, views, compression, exposure, and
penetration.
June 2013
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TG 355
Mammography
7. SPECIAL CONSIDERATIONS
Female Volunteers should be accompanied by the PCMO or by a female attendant for
screening or diagnostic mammograms performed in-country.
Women should be scheduled for screening mammography when they are not
experiencing cyclic breast tenderness or conditions that increase breast
tenderness.
8.
Close of Service (COS) screening mammography should be performed in the

country of service for PCVs in countries where mammography is available.
PCMOs should not issue a PC-127c for a COS mammogram if the PCV had
waived the mammogram accommodation. Mammography is available through
the health insurance offered at COS.
A 127C for screening mammography should read: Routine screening

mammogram.
All mammogram films should be returned to the Volunteer at COS. The PCMO
should document in the Health Record that the films have been returned (see
Technical Guideline (TG) 330 Post-Service Benefits section 4.6).
Screening mammography is required for extension of service and should be

preformed at posts on the Mammogram Accommodation list. If facilities are
not available at post, the PCMO may issue a 127C to Volunteers wishing to
obtain a screening mammogram in the U.S. while on vacation or home leave.
OHS will not medevac Volunteers for extension of service screening
mammography.
MAMMOGRAPHY REPORTS
Mammography reports should include a brief statement about the reason for the
examination, a description of the breast composition, a description of significant
findings, and a statement regarding comparison with prior examinations. These reports
should be signed and dated by the consulting radiologist and translated into English if
necessary. The American College of Radiology promotes the use of a standardized
reporting system, the Breast Imaging-Reporting and Data System (BI-RADS). Peace
Corps requires that all mammograms are reported using the BI-RADS system. It
includes one of the following overall assessments and recommendations:
June 2013
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TG 355
Mammography
BI-RADS
Category
Assessment
Recommendations
Needs Additional Evaluation
Recommend additional views and/or

sonography
Negative
Nothing to comment on; routine follow-up
Benign Finding
Also negative, however a benign finding

such as a calcified fibroadenoma is
seen; routine follow-up
Probably Benign Finding
Short interval follow-up suggested to

confirm no change in an abnormal
finding
Suspicious Finding
Biopsy should be considered
Highly Suggestive of
Malignancy
Management is based on a high

probability of breast cancer
(characteristic morphology seen)
9. INTERPRETATION OF DIAGNOSTIC AND SCREENING MAMMOGRAMS

Screening and diagnostic mammograms performed in-country can be reviewed by a U.S.based radiologist according to the following procedures:
The PCMO should:
1. Obtain the original films or digital copy of the mammogram and the report from the local
radiologist;
2. Prepare a field consult using the Mammogram Field Consult form (see
ATTACHMENT A);
3. Send the mammogram image, the local radiologists report, any prior mammograms, and
the field consult to OHS via the most efficient route (generally DHL, FedEx or other
express mail service). Address the communication to the attention of the IHC at:
Peace Corps: Attention (IHC for your post)
1111 20th Street, NW
Washington, DC 20526
4. If previous mammogram films are not available in country, the Volunteer, together with
the PCMO, should make every effort to have previous mammogram films sent to OHS
from the Volunteer's home of record (HOR). Previous films are important for comparison
as they assist the radiologist in determining the significance of new or changed breast
findings. Medical records departments in the U.S. require a Records Release
Authorization signed by the patient prior to releasing mammogram films. A "Records
Release Request" (ATTACHMENT B) is included for this purpose. If the Volunteer or
PCMO experiences difficulty obtaining films or initiating the process, the PCMO should
contact OHS for assistance.
June 2013
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TG 355
Mammography
OHS will:
Ensure that the films are read by a U.S.-based radiologist;
Review all results and reports;
Fax stateside results and, if indicated, a field consult report to country within one week of
receipt of the field consult and mammograms if previous films are readily available.
Return the films and hard-copies of the reports to post;
When necessary, obtain previous mammogram films.
10. EVALUATION OF A NEW BREAST MASS

Patient complaints of a breast mass are common. Fibro adenomas and cysts are the most
common causes of benign breast masses. About 90% of palpable breast masses in women in
their 20s to early 50s are benign, but excluding breast cancer is a crucial step in the
assessment of these masses. Findings in benign breast disease can mimic those in cancer,
since normal breast tissue in women is often somewhat nodular.
10.1 History
Older age, previous history of breast cancer and family history in a first-degree relative have
all been shown to increase the chance that a palpable breast mass is cancerous on biopsy.
10.2 Physical Exam
Physical findings individually do not distinguish well between cancers and benign lesions.
The first goal of the physical examination is to determine whether a dominant mass,
thickening, or asymmetry is present. This is particularly important in younger women, whose
breasts are more likely to be generally nodular than in older women. Some "classic"
characteristics of cancerous lesions include:
Single lesion
Hard
Immovable
Irregular borders
If the initial physical examination does not confirm the presence of a dominant mass,
thickening or asymmetry, close observation with a follow-up examination in two to three
months should be arranged to assure resolution or stability of findings. Alternatively, the
patient can be referred to a breast specialist, depending on the confidence and expertise of the
examiner.
If the initial physical exam indicates that further evaluation is indicated, then arrangements
should be made for breast imaging and OHS should be notified of the breast mass through a
field consult.
June 2013
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TG 355
Mammography
10.3 Imaging
A mammogram should be the first diagnostic test ordered in a woman over the age of 30 with
a new breast complaint. Even if the patient had a recent negative screening mammogram, if
she has a focal complaint, a diagnostic mammogram should be obtained. Mammography is
not routinely ordered in women under age 30 years. Ultrasound is the first line of imaging in
a woman who is pregnant or less than 30 years old with focal breast symptoms or findings.
However, it is not inappropriate to order a mammogram as part of a diagnostic evaluation of
a clinically suspicious mass in younger women.
Certain mammographic features such as asymmetry, clustered pleomorphic calcification,
increasing density, or a new mass with irregular borders or spiculation are suggestive of
malignancy. However, mammography cannot determine whether a mass is benign.
A negative mammogram does not eliminate the need for further evaluation of a suspicious
mass. Mammography misses 10 to 20 percent of clinically palpable breast cancers. Thus, a
negative mammogram should not stop further investigation if a suspicious mass is felt on
clinical examination. Targeted ultrasonography is a useful diagnostic test to evaluate a
palpable mass or an area of abnormality detected on mammogram. It is particularly useful for
assessing whether a mass is solid or cystic in nature.
Breast magnetic resonance imaging (MRI) is not indicated for the work-up of an
undiagnosed mass. MRI is best reserved for diagnostic dilemmas and used with discretion as
there is a significant false positive rate, which dramatically increases the rate of benign
biopsies. Diagnostic breast MRIs should only be performed in institutions that have capacity
for MRI directed biopsy, as lesions seen on MRI may not be visible on other imaging
modalities.
The findings of breast imaging will dictate the next steps in the evaluation of the breast mass.
OHS should be made aware of any imaging reports that indicate a finding of BI-RADS
category 3, 4 or 5.
REFERENCES
American College of Radiology. ACR Practice Guideline for the Performance of Screening and
Diagnostic Mammography. 2008.
http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm
http://www.uptodate.com/contents/breast-masses-and-other-common-breastproblems?source=search_result&search=breast+mass&selectedTitle=1%7E41#H19
June 2013
Page 7
Applicant Name: ____________________________________________________________

IMPORTANT I NFORMATI ON ON SCREENI NG MAMMOGRAMS
PLEAS E COMPLETE THIS FORM AND RETURN IT
WITH THE REPORT OF MEDICAL EXAMINATION
Most major health organizations recommend that women over the age of 40 receive regular,
comprehensive screening for breast cancer, including mammography every one to two years.
The Peace Corps strongly supports these recommendations and is able to provide screening
mammography in some but not all of its overseas posts. The Peace Corps would like to
facilitate access to screening mammography by recommending an overseas assignment for
you in a country where you can receive a routine screening mammogram. After discussing
the matter with your phys ician, please choose one of the two options outlined below under
Instructions to Peace Corps Applicant.
Instructions to the Physician:

Please read the above statement, discuss it with your patient, check all of the following that apply, and sign.
I have discussed with the above-named person the consensus medical opinion that
regular, comprehensive screening for breast cancer, including screening mammography
every one to two years, is medically indicated for her age group and I concur with the
Peace Corps Office of Volunteer Support willingness to recommend that she serve in a
country where she can receive a routine screening mammogram for breast cancer.
I have reviewed and assisted in the completion of the Mammogram Health Assessment
Questionnaire with the above-named person.
I have discussed with the above-named person the fact that foregoing a routine screening
mammogram for more than two years may subject her to risk of delayed diagnosis of
breast cancer, which could cause major adverse health consequences, including death.
______________________
(Physician Printed Name)
_______________________
(Physician Signed Name)
Instructions to Peace Corps Applicant:
_____________
(Date)
Please check one of the following and sign.
After discussing these matters with my doctor, I have decided that I wish to ensure that I
receive a routine screening mammogram during my 27 months of Volunteer service.
(You do not need to fill out the Mammogram Health Assessment Questionnaire)
After discussing these matters with my doctor, I have decided that I do not wish to
ensure that I receive a routine screening mammogram during my 27 months of Volunteer
service. You must complete the attached Mammogram Health Assessment Questionnaire.
Based on that information and/or your mammogram report, you may be given a
mammogram accommodation and will be considered for placement in a country where
this resource is available.
________________________
(Applicant Printed Name)
Version September 2008, reviewed 2012
________________________
(Applicant Signed Name)
____________
(Date)
Mammogram Health Assessment Questionnaire

The questions below must be answered in order to make a general assessment of your
statistical breast cancer risk. These questions can be answered by you and do not require
additional medical tests or physician visits.
If you do not know the answer, you may consult with your physician or simply respond
no to questions that require a yes or no answer.
Yes
No
Do you have a personal history of breast cancer, ductal carcinoma in situ

(DCIS), or lobular carcinoma in situ (LCIS)?
In order to estimate your cancer risk:

____years
____ years
N/A
N/A
No
N/A
No
N/A
OPTIONAL
#_______
Yes
#_______
Yes
At what age did you begin to have your menstrual periods?

At what age, if applicable, did you have your first child?
How many first-degree relatives (parent, sibling, child) have had
breast cancer?
Have you ever had a breast biopsy?
How many breast biopsies have you had (positive or negative)?
Have any of the biopsies shown atypical hyperplasia (check with your
doctor if necessary)?
Understanding that race and ethnicity factor into the estimation of breast
cancer risk, what is your race/ethnicity? (check all that apply)
White
African-American
Hispanic
Asian, Pacific Islander or Native Hawaiian
American Indian or Alaskan Native
Unknown
Prefer not to answer
Version September 2008, reviewed 2012
TG 355 ATTACHMENT B
MAMMOGRAM FIELD CONSULT

TO:
FROM:
DATE:
NAME:
INDICATION FOR MAMMOGRAM:

[ ] SCREENING
DOB:
COS DATE:
[ ] DIAGNOSTIC (Evaluation of breast condition)
PAST MEDICAL HISTORY:

Pregnancy history .................................................................................
History of abnormal breast exam or breast finding................ ............
History of diagnostic procedures or needle aspirations ..................
History of breast disease or breast cancer .........................................
History of breast surgery ......................................................................
Family history of breast disease or cancer ..........................................
[
[
[
[
[
]
]
]
]
]
YES
YES
YES
YES
YES
[
[
[
[
[
]
]
]
]
]
NO
NO
NO
NO
NO
[
[
[
[
[
]
]
]
]
]
YES
YES
YES
YES
YES
[
[
[
[
[
]
]
]
]
]
NO
NO
NO
NO
NO
If YES to any of the above, please describe below:
CLINICAL EXAM:
LMP: ...........................................................................................................
On oral contraceptives or hormone replacement therapy ....................
Palpable lump or mass ...............................................................................
Breast tenderness or pain .........................................................................
Nipple discharge.........................................................................................
Lymph nodes ..............................................................................................
If YES to any of the above, please describe below. For palpable abnormalities, include specific location,
i.e., breast (left or right), quadrant (upper outer, upper inner, lower outer, lower inner). A graphic
representation of the breast may be used.
RIGHT
PREVIOUS MAMMOGRAMS
Available in country ..........................................................................
[ ] YES
LEFT
[ ] NO
If yes, send previous mammograms and report to VS with the current mammogram study.
If no, please initiate the process of having Volunteer's previous mammogram films sent from her HOR to VS
as soon as possible (see TG 355 section 6).
Revised February 2012
TG 355 ATTACHMENT C
RECORDS RELEASE AUTHORIZATION

(MAMMOGRAM FILMS AND REPORTS)
DATE OF REQUEST:
PATIENT INFORMATION:
Patient's name:
DOB:
Country of service:
LOCATION WHERE PREVIOUS MAMMOGRAMS MAY BE OBTAINED:
Clinic name:
Address:
Telephone number:
Fax number:
Date of last mammogram:

AUTHORIZATION:
I,
, hereby request that the following information

(Name)
Mammogram Films and Radiologist Reports
be released to the Peace Corps
Office of Volunteer Support. Please send original films and reports to:
Peace Corps
1111 20th Street, N.W.
Washington D.C. 20526
Attn:
International Health Coordinator
(202) 692-1500
Privacy Act Statement: I understand that all information in my record will be released, including
dates, history of illness, and diagnostic and therapeutic information related to my condition.
Patient Signature:
Date
Witness:
Date
Peace Corps
Technical Guide line 3 60
USE OF U.S. LABORATORIES
1 . PURPOSE
To prov ide P eace Corps Medical Officers (P CMOs) with guidance on :
The use of laboratory services in the U.S.;
P roper packaging and shipp ing of specimens;
P roper procedures for obtain ing lab oratory results.
2 . B ACKGROUND
The Office of Health Services (OHS) arranges and pays for laboratory serv ices for all P eace
Corps p osts at the laboratories referenced below (see section 3).
P CMOs may use local laboratory services when in-cou ntry facilities are adequate. The
P CMO together wit h the Regional Medical Officers (RMOs) are responsible for mak ing th is
determinat ion. Costs for in-country laboratory services are paid from the country bu dget.
3 . U.S. LAB S USED B Y PEACE CORPS

Quest Diagnostics Nichols Institute (Quest) is the main U.S. lab oratory used by P eace Corps.
When request ing the services of a U.S. lab, unless otherwise ind icated , P CMOs shou ld send
all general p urpose labs to Quest . The Centers for Disease Control and Prevention (CDC)
laboratory provide P eace Corps with spec ia lty services. P CMOs should use the following
laborat ories and services according to the gu idance out lined below.
U.S. L ABS AND SER VICES
LABORATORY
Quest Diagnostics Nichols
Institut e
Office o f Health Services
SERVICES
General purpos e laboratory
s ervic es (see Quest
Direc tory of Servic es )
HIV testing
February 2013
ADDRESS
Quest Diagnostics Nichols Institute
14225 Newbrook Drive PO Box 10841
Chantilly, VA 20153-0841
P ag e 1
TG 3 60
U.S . Labo ra to ries
LABORATORY
Centers for Dis ease Control
and Prevention (CDC)
(c ontinued)
SER VIC ES
Malaria slide ex amination
Mefloquine blood levels

Malaria Branc h,
Building 109, Rm 1302, Mailstop F-36
4770 Buford Highway
Atlanta, GA 30341-3724
Sc histos omiasis antibody
DASH-Parasitology
CDC MS G-12
1600 Clifton Road
Atlanta, GA 30333
Hepatitis E antibody

Data & Specimen Handling Sec .
4770 Buford Highway
Atlanta, GA 30341
Antibody testing for viral and

bac terial dis eas e
Other s pec ialty tests
Quest Diagnostics Nichols
Institut e
ADDRESS
Mic roscopic ex amination for

paras ites (stool, urine)
Quest Diagnostics Nichols Institute

14225 Newbrook Drive PO Box 10841
Chantilly, VA 20153-0841
4 . SPECIM EN PRESERVATION, PACKAGING, LAB ELING AND SHIPM ENT

Note: The term container is u sed to d escribe the specimen packaging requiremen ts in section 4 .2 , a nd the
term bo x is u sed to des crib e the sh ipp ing requ iremen ts in section 4 .4 .
4 .1 Specimen Preservation
Unrefrigerated specimens: Unrefrigerated specimens may become contaminated

by bacterial growt h, making the specimens un usab le. The addition of an antib iot ic
to reduce bacterial growth is recommended if co ld packs or ice packs are not being
used. The simplest met hod is to add a gentamycin- impregnated paper d isk to the
serum samp le. P CMOs can procure these disks (used in ant ib iot ic sensit iv it y
testing of bacterial cult ures) thro ugh the Post Logistics and Support Division (PLS)
in Washingt on.
Refrigerated or frozen s specimens: Specimens sent refrigerated or frozen must be

packed in a Styrofoam container with co ld packs. Cold packs remain active for
approx imately seven days.
Due to the lon g transit t ime from post to the U.S., specimens requiring refrigerat io n
should only be sent to U.S. laboratories when no alter nat ive exists. If P CMOs send
February 2013
P ag e 2
TG 3 60
specimens requiring refrigerat ion, they should send t hem directly to the lab oratory
via an express mail system, i.e., DHL or other. Specimens sent t hro ugh an express
mail system may be subject to delay at the U.S. port of entry f or custo ms clearance.
P CMOs should consult t he Quest Directory of Services for specific informat ion on
specimen preparation and preservat ion of indiv id ual tests (see section 5. 1 below).
4 .2 Specimen Pack aging
By federal regulat ion, diagnostic specimens and bio logic products sh ip ped within the
U.S. must be packaged to withstand leakage of contents, sh ocks,pressure changes, and
ot her cond it ions incident to ordinary hand ling in transportation (42 Code of federal
Regulat ions (CFR) P art 72).
P CMOs should package specimens of b lood or other potentially infectious material
being ship ped to the U.S. in the following way:
Prima ry co ntainer: P lace each specimen in a watertig ht tube or container, e.g.,

plastic screw top serum t ube, specimen container, or slide ho lder. P lace adhesive
tape around all t ops. Avoid contamination of the outside of the container.
Requisition slip: P lace the requisition slip in a zip lock plastic bag. This protects the
requisition slip from leakage or contaminat io n.
Secondary co ntainer: P lace the primary container and the requisition slip inside
the zip lock bag in a second watertight container with absorbent material. A
Styrofoam packing container, malaria kit container, or ot her container placed in a
leak proof (ziplock) bag is sufficient.
For addit io nal information, see also Technical Guideline (TG) 2 60 sect io n 5.2
S pecimen P ackaging and TG 2 60 Attachment A P ackaging Specimens.
4 .3 Specimen Labe ling
Specimen Labels: P osts may create preprinted labels to be added to the chart
of incoming trainees. If labels are not availab le specimens and slides should be
labeled as follows:
S pecimen Contain ers

Date
Patient n ame
Coun try
Date o f Birth (DOB)

Sex
Slides
Patient in it ials o r name
Date o f Birth
Please note that use of adhesive labels is not acceptable for use on specimens that
are placed on slides. Information must be written in pencil on the frosted glass
portion of the slide.
February 2013
P ag e 3
TG 3 60
4 .4
Specimen Biohaza rd Labels: Specimens and ot her infectious material being sh ipped
to the U.S. must be appropriately labeled as a bio hazard.
Eit her the primary or t he secondary container describe d abo ve must have a
warning label that includes the universal biohazard symbol followed, by t he
term biohazard. A red bag or red container ma y be subst it uted f or a label.
P lastic specimen bags with the red biohazard symbol may also be used and
can be procured through OSD. See TG 260.5 f or add it ional information on
specimen handling and labeling.
The P CMO may label both the primary and secondary containers but is not
requ ired to do so.
Biohazard labels should also include Glass, Fragile, Refrigerate, or

Do Not Freeze designations as appropriate.
Specimen Shipment
P rior to shipment, secondary container(s) must be placed inside one or two cardb oard
boxes as follows:
Double Box: Specimens sent b y diplo mat ic pouch or hand carried to the US mail
room for forwarding to U.S. laboratories must be do ub le boxed.The outer b ox
should be addressed to:
P eace Corps Mail Roo m
1111 20the Street, N.W.
Washingt on, D.C. 20526
Attention: Lab Specimens
Each inner bo x must be accurately addressed to its final dest inat ion, e.g., Quest
Diagnostics ; CDC, etc. (see addresses in section 3 above). Each inner package must
contain specimens samples dest ined f or one and only one U.S. laboratory.
S ingle Bo x: Double boxing is not required if t he package is sent d irect ly from post
to a U.S. lab. A single cardboard box addressed directly to the reference lab (see
addresses in section 3 above) is sufficient.
Rigid mailing sleeves, if properly reinforced for o verseas shipment , may be used
instead of boxes for shipment of specimens.
5 . QUEST DIAGNOTICS NICHOLS INSTITUTE

Quest is the main U.S. laborat ory used by P eace Corps. P CMOs shou ld use Quest for any test
that is n ot availab le locally and when in-cou ntry laboratory facilit ies are not adequate or
reliab le. P CMOs use Quest most frequent ly for P ap smear cytology, urine and stool O&P
testing, pathology, and HIV tests.
February 2013
P ag e 4
TG 3 60
5 .1 Quest Directory of Se rv ices and Requisition Fo rms

Through PLS, Quest can supply posts with a current Quest Directory of S ervices.
The Directory contains a comp lete list of t he tests offered; information on how to order
and prepare specimens for submission; information on available lab supplies, shipp ing
materials, and profiles; and interpret ive information. The Director y shou ld be available
in t he healt h un it or it can be procured through PLS. The directory is also available online via the Quest Care 360 system.
Quest also supplies posts with pre-printed Quest requisition forms. These forms are standard
test request forms that have been pre-printed with the headquarters address and a master
account number; there are a few high volume posts that do have individual sub-accounts
under the master account n umber. All other posts will access results under the
Quest Master account number. The number is located on the middle of the forms above
the headquarters address or it may be obtained t hrough the Internat ional Health Coordinator
(IHC). PCMOs should inform OHS if there is a change in the posts mailing address.
5 .2 Quest Supplies
Quest will provide to P eace Corps posts the following lab oratory su pp lies an d
shipping materials for ordering tests. There is no charge to post f or these Quest
supp lies.
Lab Supplies
Seru m separat or tu bes 15 ml

Gray top tub es 5 ml
Seru m v ials
Mu ltip le n eed les
VCE slides
Sp ray fixat iv e
GC/ Ch lamy d ia DNA test p rob es
Lav end er top tub es 5 ml

Blu e to p tu bes 4.5 ml
Cu ltu rettes
Va cut ainer ho ld ers
Cy to logy b rush es
Slid e ho lders
ParaPak supplies for stool O&P testing
Shipping Supplies
Q u e s t mailers / Sty rofo am
Plastic zip lo ck bags
Cardboard bo xes
A bso rben t p ap er
Forms
Clien t Supp ly Order Re quest Fo rm
Cy to logy / His tology Request Fo rm
General Requ est Fo rm

Directo ry of Serv ices
These supp lies are provided only upon request from post to PLS. P CMOs shou ld order
Quest supplies through PLS using the Quest Supp ly Order Request For m or
by email request. Request forms can be obtained from PLS. Supp ly req uests sh ou ld not
b e sent directly to Quest.
February 2013
P ag e 5
TG 3 60
Quest supplies will be shipped t o post via d ip lomat ic po uch or AP O. If supplies

cannot be shipped t hrough the diplo mat ic pouch or AP O, fiscal coding for sh ipp ing
must be included with the order.
5.3 Communication with Quest

P CMOs with questions or co ncerns about specific la b results ma y contact Quest at
01-703-802-6900 (see section 10 below).
6 . CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

P CMOs should use the CDC for the services listed below. Specific requisit ion forms are
required for t he various services and these are listed below. Unless a specific request for m
has been prov ided (see above), P CMOs should use the Reference and Disease Surveillance
Request For m, CDC 5 0.34 (ATTACHM ENT A) to request testin g by CDC.
SER VIC ES
REQUISI TION FORM
Malaria slide ex amination.

Mefloquine blood levels
Malaria Cas e Record (TG 845, Attac hment A)
Sc histos omiasis antibody
Requisition form provided by CDC
Hepatitis E antibody
Peac e Corps Viral Hepatitis Cas e Report (TG 650,

Attachment A)
Antibody testing for viral and

bac terial dis eas e
Other specialty tests
Referenc e and Diseas e Surveillanc e Request Form, CDC

50.34 REV.11-90 (TG 360, Attac hment A)
Send specimens to the Centers for Disease Control and P revent io n. See section 3 above for
addresses.
7 . QUEST DIAGNOSTICS NICHOLS INSTITUTE

P CMOs may use Quest for microscopic examinat ion of stoo l and urine specimens for
parasites. Quest will also performthese tests. See TG 815 Stool Test in g for P arasites
for addit ional information (Note: malaria slide stud ies should to be sent to t he CDC as
described in section 6 above.)
SER VIC ES
Mic roscopic examination for
paras ites (stool, urine)
REQUISI TION FORM

General Request form. Include with spec imen: date,
patient name, c ountry , and test des ired.
Send specimens to Quest Diagnostics (see section 3 abo ve for address).
February 2013
P ag e 6
TG 3 60
10 . OB TAINING LAB RESULTS

All resu lts fro m Quest will be available to P ost and OHS electron ically at
https://cas2.questdiagnostics.com/ . All ot her U.S. labs used by P eace Corps send
results t o the field, either t hrough OHS or d irect ly to the field.
HIV Test and COS Lab Results
In-service indeterminate or posit ive HIV results are received by the P CMO and reported
by the P CMO to OHS
COS lab reports are received, evaluated and filed in t he medical record by t he P CMO
prior to packaging of t he health record for shipment to P eace Corps headquarters
All medical records are required to be received at P eace Corps headquarters with in 30
days after COS
Any abn ormal COS test resu lts that are received after the Volunteer has closed serv ice
must be reported to t he P ost Service Un it (P SU) mailbox v ia secure file transfer (SFT) :
psu@peacecorps.gov
P CMOs with questions or concerns about specific la b results ma y contact Quest

Diagnostics direct ly at 01-703-802-6900. All communicat ion should include the name of
the test, Vo lunteer name and date of birth, and the date specimen was sent.
P CMOs should contact IHC if they have further prob lems obtaining laborat ory results from
Quest or other labs out lined in this guide line.
February 2013
P ag e 7
TG 360 ATTACHMENT A
Page 1
TG 360 ATTACHMENT A
Page 2
TG 360 ATTACHMENT B
Request for KSU Rabies RFFIT Serology

For Human Specimens Only
For KSU Lab Use Only

Submit To:
Dr Deborah Briggs, Director/RFFIT
Mosier Hall
1800 Denison Avenue
Kansas State University
Manhattan KS 66506-5600
Phone/Fax: (785) 532-4483 / 532-4474
Lab Number:
Please Provide all Requested Information. Blanks may delay processing.

Address For Results:
Name:_________________________________________________________________________________
Address:_______________________________________________________________________________
State,
City:__________________________________Province:___________________Zip:___________________
Country:________________________Phone/Fax:______________________________________________
Patient(s) Information:
Circle one:
Name
Endpoint or Screen Sex
Date
Age
Rabies Vaccination History of Draw
1.______________________________________________________________________________________________
2.______________________________________________________________________________________________
3.______________________________________________________________________________________________
4.______________________________________________________________________________________________
5.______________________________________________________________________________________________
6.______________________________________________________________________________________________
7.______________________________________________________________________________________________
8.______________________________________________________________________________________________
9.______________________________________________________________________________________________
10._____________________________________________________________________________________________
Signature of Submitter:_________________________________________Date:______________________
If a separate billing address is desired, please note.
Opened by:____________ Processed by:____________ Computer Entry:____________ Verified by:____________ Reviewed by:____________
Peace Corps
FIELD CONSULTATION AND COMMUNICATION
1. PURPOSE
To provide guidance on the use of field consultation in the Volunteer Health System.
To outline the methods of communication between the Office of Medical Services (OMS)
and Peace Corps Medical Officers (PCMOs).
2. BACKGROUND
Clinical care overseas relies on the following resources:
PCMO training, licensure, skills and experience;
Health unit equipment and capabilities;
Qualifications and availability of local consultants;
Practice guidelines as established through Technical Guidelines (TGs);
OMS authorized protocols;
Consultation with OMS and other medical resources in the U.S.;
Medical evacuation when an illness or injury requires evaluation and/or treatment beyond
the scope of care available locally.
A field consult is a clinical inquiry by overseas medical personnel to OMS. OMS in turn
utilizes all necessary medical resources and specialists in the U.S. to inform and respond to
the inquiry. Field consultation is used when a medical condition: (1) involves the potential
for significant complications; (2) requires resources or expertise that exceeds the PCMO's
training, skills and qualifications; or (3) approaches the limits of diagnostic and/or
therapeutic care available in country. The field consultation process is an integral component
of the Volunteer Health System, and PCMOs should use the process when indicated.
3. OMS/OSS CONTACT INFORMATION

Following are the main fax and telephone numbers for the Office of Medical Services. All
field consults and communications with OMS should be conducted through these numbers.
August 2008
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TG 370
Field Consultation
Routine
(Non-Urgent)
During Business Hours
After Business Hours

(weekends, holidays)
Contact IHC through the main

OMS switchboard
(202-692-1500)
Contact IHC during regular

business hours
OMS Fax
(202-692-1501)
Urgent
Contact IHC through the main

OMS switchboard
(202-692-1500)
Contact the Medical Duty Officer

(301-790-4749)
These numbers are up to date as of the publication of this TG. Posts should ensure that their
contact information is accurate and up to date.
4. INDICATIONS FOR FIELD CONSULTATION

PCMOs should consult OMS in any clinical situation that requires information, resources, or
expertise that exceeds the training, skills, and qualifications of the PCMO and local
consultants.
In addition, PCMOs should consult OMS in the following situations:
4.1
4.2
General Indications
Volunteer requests a second opinion and post does not have a qualified provider.
Local resources cannot provide safe, efficient, and timely care that conforms to U.S.
standards and norms.
To confirm or supplement a medical or dental opinion obtained locally.
To establish the technical merits or reliability of local resources including, but not
limited to radiology, laboratory, medical and dental facilities and personnel.
TGs specify OMS consultation.
Specific Clinical Indications
Trainee or Volunteer has a significant illness, injury, or psychiatric problem.
Discuss or confirm a PCMO differential diagnosis, diagnosis, or treatment plan.
Prior to surgical procedures.
Prior to invasive procedures, e.g., endoscopy, colonoscopy, biopsies.
Volunteer has a new onset or poor control of a major or chronic medical condition,
e.g., diabetes, asthma, hypertension, angina.
August 2008
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TG 370
Field Consultation
When a clinical presentation of uncertain etiology may represent a serious

underlying condition, e.g., chest pain of possible cardiac etiology; syncope that may
represent a significant CNS event or lesion.
When a condition or diagnoses carries a possible prognosis of long term disability

or morbidity, e.g., traumatic injury with possible of loss of function.
When a condition may lead to significant cosmetic deformity, e.g., large facial
lacerations, facial leishmaniasis.
When a condition or diagnosis is associated with a significant radiographic

abnormality;
After a physical or sexual assault where there is significant trauma or psychological

issues.
Consideration of Post Exposure Prophylaxis PEP after possible exposure to HIV.
Consideration of a medical evacuation (see TG 380 Medical Evacuation).
5. FIELD CONSULT PROCEDURES

5.1
Directing Field Consults

In general, field consults should be directed to the regional International Health
Coordinator (IHC) in OMS, via fax, cable, or telephone, for action (see
Communication with OMS below).
In countries with Area Peace Corps Medical Officers (APCMOs), non-urgent field
consults should be directed to the APCMO with a copy to OMS. Urgent field consults
should be directed to both the APCMO and OMS for action.
5.2
Field Consult Format

All field consults should be organized in SOAP format (see TG 210 Health Records
section 7.1 SOAP Format) and submitted with the following supporting information:
5.3
Volunteer name, SSN, DOB, COS date;
Presentation of case and documentation of clinical care in SOAP format;
Copy of relevant diagnostic test reports, e.g., x-rays, laboratory studies, ECGs, etc.;
Copy of relevant chronological notes from the health record;
Radiographic studies and photographs if post has the ability to transmit digitally.
OMS Response
The IHC, in consultation with the Chief of Clinical Programs, reviews all field consults.
Following review, field consults are answered directly by medical professionals in
OMS or are referred to outside specialists in the Washington, DC area.
August 2008
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TG 370
Field Consultation
Urgent field consults for an acute medical problem or an urgent medevac consideration
are handled as an emergency, and a response is sent to post as quickly as possible.
Non-urgent field consults are answered within two business days. If outside specialist
consultation is required by OMS, a response will be sent to country within two days of
OMS receipt of the specialists opinion.
All consults are sent to post immediately via cable, fax or telephone. If PCMOs do not
receive a response from OMS within a reasonable time frame, they should follow-up
with their IHC directly.
6. METHODS OF COMMUNICATION
Field consults and other communication with OMS may be by fax, cable, or telephone. The
method of communication should be determined by the urgency of the medical problem, the
time of day, the day of the week, the confidentiality of the material being communicated, and
the reliability of communication services at post.
The health unit should maintain a log or tracking system for outgoing cables and faxes.
Health unit staff should be able to verify from their logs that a communication was
transmitted and the date of transmission.
6.1
Non-Urgent Communication
Fax Transmissions
For non-urgent field consults, the preferred method of communication is by fax.

Faxes should be sent directly to the IHC via the main OMS fax number (202-6921501). This fax number is the designated destination for all medically confidential
information.
Faxes should indicate clearance by the originator and any clearing officials.
All faxes that identify an individual Volunteer and contain medical information
should be designated as Medical Eyes Only. A cover sheet indicating that the
information on the following pages is Medically Confidential should be used as a
safeguard when sending medically confidential information.
Health units should have a dedicated fax to which medically confidential

information can be sent at any time. If a dedicated fax is not available, each post
must establish procedures to assure that confidentiality is maintained when medical
information is transmitted to the fax. Such procedures include:
Notification to OMS that a Medical Eyes Only fax is not available;
Envelopes marked Medical Eyes Only convenient to the fax so that

documents can be sealed upon receipt;
Logs indicating non-medical staff who handled Medical Eyes Only

documents.
August 2008
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TG 370
Field Consultation
PCMOs should contact OMS if the health unit does not have a Medical Eyes Only
fax and there are concerns about the security of medically confidential information.
Telephone
The PCMO may obtain a medical consultation via telephone, i.e., a telcon.
All telephone consults about patient care must be documented. Documentation is

required to confirm the accuracy of the information exchanged and to protect the
parties involved in the consult from misunderstandings. The individual who
initiates the call is responsible for documenting the telcon and sending a summary
fax or cable to confirm the consultation.
PCMOs calling from overseas during business hours should use the main OMS
switchboard number (202-692-1500). The PCMO should identify him or herself as
a PCMO and indicate that he or she is calling from overseas. The administrative
assistant who answers the telephone will ensure that the call is transferred to the
appropriate OMS staff.
Email
All confidential information should be sent using Secure File Transfer Protocol
(SFTP). Contact OMS if there are any questions regarding use of SFTP.
Cable Transmissions
6.2
Cables are only used when fax or e-mail communication is not practical. Section 7
Cable Preparation below outlines the preparation of a cable. Routine cables take
12-24 hours to reach Washington.
Urgent Communication
Telephone: During business hours (7:30 a.m. to 5 p.m. eastern time Monday
through Friday).
For urgent concerns during business hours the PCMO should contact field support
directly through the main OMS switchboard (202-692-1500). When calling the
OMS switchboard, PCMOs should identify themselves, state the urgency of the
call, and state with whom they would like to speak. The administrative assistant
who answers the phone will ensure that the call gets to the requested OMS staff.
Telephone: After business hours, weekends and holidays.

For all medical emergencies and urgent concerns that arise during non-business
hours, PCMOs should contact the OMS Medical Duty Officer via the Peace Corps
answering service (301-790-4749). The Medical Duty officer is available 24 hours a
day, 7 days a week. When calling, PCMOs should provide their name, country, a
return telephone number, state the urgency of the call, and request to speak with the
Medical Duty Officer. The Duty Officer should return the call within 20 minutes. If
August 2008
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TG 370
Field Consultation
the PCMO does not receive a response within 20 minutes of the call, he or she
should contact the service again.
Night Action Cable (NIACT).

If telephone communication is impossible, the Administrative Officer at post should
request assistance of the American Embassy to send a NIACT cable (Night Action
Cable). The State Department will then contact the Medical Duty Officer who will
respond accordingly.
If Communication is Impossible.
Under extraordinary circumstances immediate communication with OMS may be
impossible. In these circumstances, PCMOs should use their clinical judgment and
all available resources to provide necessary care to an ill or injured Volunteer. In
these situations, the PCMO should contact OMS as soon as possible after
communication has been restored.
7. PREPARATION OF MEDICAL CABLES

Equipment and procedures for cable transmission vary from one Embassy to another.
PCMOs should familiarize themselves with local embassy procedures.
General Information
A PCMO authorizes transmission of medically confidential cables. The Country Director

(CD) authorizes transmission of all other cables.
Medical Eyes Only is reserved for medically confidential cables. Copies of this type of
cable are distributed to OMS staff and overseas Peace Corps medical staff only. The term
Med Channel is not used by Peace Corps.
All Peace Corps cables are unclassified.
Minimize is a control procedure imposed during emergency situations to reduce all

cable traffic not related to the emergency. If a post is under a minimized condition, the
embassy or the Department of State specify approval procedures for cables.
Cable Preparation
Follow directions in the Peace Corps Cable Preparation Guide (1992) available from the
Office of Information Resources Management (M/IRM/CTIS). A summary of the parts of
a cable is provided in ATTACHMENT A.
Use Optional Forms 152(H) and 152a(H), continuation sheets, or the cable template
distributed by M/IRM/CTIS. The spacing between lines is critical as cables are optically
scanned for transmission. If the scanner can not find the information it is looking for, e.g.,
embassy city, on the correct line, the cable will be rejected.
August 2008
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TG 370
Field Consultation
Cables addressed to a post where there is no U.S. Embassy will be automatically

transmitted by fax, i.e., Apia, Western Samoa; Kolonia, Micronesia; Tarawa, Kiribati;
Port Vila, Vanautu; Nukualofa, Tonga; and Castries, St. Lucia.
The following symbols may not be used in cables: *, #, $, &, +, % as the optical scanner
will not read them.
REFERENCES
Manual Section 832 Cables and Facsimile Transmissions.
Technical Guideline 150 Medical Confidentiality.
Peace Corps Cable Preparation Guide (available from M/IRM/CTIS).
August 2008
Page 7
TG 370 ATTACHMENT A
PARTS OF A CABLE
The following description of the basic parts of a cable may be used when preparing a cable. Medical
Officers should contact the Office of Information Resources Management (M/IRM/CTIS) in Washington
or the local U.S. Embassy for post-specific procedures.
1.
Cable Identification Numbers

The State Department in Washington and U.S. Embassies overseas use sequential numbering
systems during a calendar year. Thus,
LOME 1109
identifies this cable as the 1109th cable of the year to be sent from the Embassy in Lome.
2.
Date and Time of the Cable

Cables are usually dated and timed in the following sequence: DATE/TIME/MONTH/YEAR. For
example:
152025 MAY 94
This means that the cable was sent on the 15th of May 1994, at 2025, i.e., 8:25 p.m.. Times should
always be expressed using a 24-hour clock.
3.
Originator Identification
The originating (sending) facility is identified as follows:
FM AMEMBASSY LOME
Thus, this cable originated from the U.S. Embassy in Lome, Togo.
4.
Action Addressee(s)
The action addressee is the cable address of the person or office whom the writer of the cable
intends to take appropriate action on the contents of the cable. For example:
TO SEC STATE WASHDC
indicates that the cable address of the person for whom the cable is intended is the State Department
in Washington, which will forward the cable to Peace Corps (see 7, below).
5.
Precedence Designation
Cable precedence governs the order in which cables are transmitted through the system and the
actions required for delivery at the receiving post. The following precedence is used by Peace
Corps:
Routine;
Priority: messages requiring rapid action and prompt delivery;
Immediate: limited to important matters that require immediate attention or action;

Page 1
TG 370 ATTACHMENT A
6.
NIACT Immediate (or Night Action Immediate): the cable will be delivered to the addressee
without regard to the time of day or night.
Information Addressee(s)
An info addressee is the cable address of a person or office whom the writer wants to have
knowledge of the contents of the cable. It is the equivalent of a carbon copy of a memorandum.
For example:
TO SECSTATE WASH, IMMEDIATE
INFO AMEMBASSY BANJUL
This designation indicates a cable to Washington with an information copy to the American Embassy
in Banjul, Gambia.
7.
P.C. (Agency Identification Code)

P.C. is a cable abbreviation for to Peace Corps. It alerts Embassy and State Department
Communications Offices that the cable is intended for a person or office at Peace Corps.
8.
Medical Eyes Only

MEDICAL EYES ONLY (Med Eyes Only) is a Peace Corps designation that ensures handling of the
cable in such a way that medical confidentiality will be preserved. Cables so designated have
distribution limited to medical personnel. They should be sent to and from the communication office
in a sealed envelope marked MED EYES ONLY.
Med Eyes Only should not be used for correspondence regarding policy, procedure, supplies, etc.
9.
To
This is the specific person and/or office to which the cable is intended. Therefore,
TO: DGOOTNICK, VS/MS
indicates that the cable is intended for D. Gootnick, Director of Medical Services.
10. From
This is the specific person and/or office sending the cable. Thus,
FROM: DR. H. GLUCKSBERG, APCMO/LOME
indicates that the cable was sent by Dr. H. Glucksberg, the APCMO, in Lome, Togo.
11. E.O. 12356

This refers to an Executive Order which deals with declassification of materials. Since Peace Corps
cables are unclassified, it is not applicable (N/A). Therefore,
E.O. 12356:
N/A
Page 2
TG 370 ATTACHMENT A
12. Tags
Tags are designations used by State Department for the filing and distribution of cables. Peace
Corps does not use this system. Therefore,
TAGS:
N/A
13. Subject
The topic of the cable. Therefore, a specific PCV would be referenced as follows:
SUBJ:
PCV JANE DOE
SSN 123-45-6789
14. References
References are previous cable correspondence on the same subject. For example,
REF:
LOME 0980
indicates Cable No. 0980 from Lome contains information on the same subject.
15. The Message

The message should be brief but clear. Repeat important information, especially numbers. For
example:
WORKING DX ICD-9-CM 002.0 RPT 002.0
the working diagnosis is ICD-9-CM 002.0 Repeat 002.0
16. Signature
All official cables bear the name of the Chief of the originating facility, e.g., the Ambassador, the
Charg, the Secretary of State, etc. In the example case,
BRAY
refers to Ambassador Bray. This does not mean these cables must be approved by the individual.
17. Classification
All Peace Corps cables are unclassified and are designated as such.
18. YY
YY indicates to the optical scanner that it has reached the end of the message.
Page 3
Peace Corps
MEDICAL EVACUATION
1. PURPOSE
To provide guidance on the medical evacuation (medevac) of Peace Corps Volunteers

and Trainees.
To provide Peace Corps Medical Officers (PCMOs) with the framework for developing a
comprehensive Medical Evacuation Plan that is specific to the needs and circumstances
of each post.
2. BACKGROUND
Medevac is any transfer of a Volunteer across an international border in order to reach a
higher level of care. In general, medevac is indicated when an illness or injury requires
evaluation and treatment beyond the scope of care available in-country through: (1) the Peace
Corps health unit, (2) field consultation, and (3) approved in-country consultants and
resources. In general, conditions requiring medical evacuation are of an urgent nature, and
evaluation and treatment cannot be delayed until after the Volunteer closes service.
The majority of medevacs are to the U.S. In certain circumstances, however, medevacs are to
a regional evacuation site or other non-U.S. location.
See Technical Guideline (TG) 385 Emergency Medical Evacuation for guidance on
medevac of an acute or life-threatening illness or injury that requires emergency air rescue by
a chartered aircraft to ensure timely delivery of care.
3. INDICATIONS FOR NON-URGENT MEDICAL EVACUATION

Situations that may require medical evacuation include:
Non-emergency or elective surgery that cannot be safely performed in-country;
Procedures requiring general anesthesia;
Conditions requiring diagnostic testing or treatment modalities beyond the capabilities of

the host country, e.g., colposcopy, colonoscopy, evaluation of complicated fractures;
Evaluation of conditions that have not responded to treatment efforts in-country;
Pregnancy counseling;
Substance abuse evaluation and treatment;
Psychiatric conditions that require evaluation and treatment beyond the management
capabilities of post;
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Sexual or physical assault;
HIV post exposure prophylaxis, if unable to be administered at post.
4. PREPARATION AND PLANNING

To ensure preparedness, each post must develop and maintain two documents: (1) a Medical
Evacuation P lan and (2) an Emergency Action Plan.
4.1
Medical Evacuation Plan

The Medical Evacuation P lan is a comprehensive, country-specific resource designed
to assist each Peace Corps post with the safe and efficient evacuation of Volunteers.
The PCMO, with support from country staff and OMS, is responsible for developing
the Medical Evacuation P lan.
Section 5 below provides detailed guidance on developing the Medical Evacuation
Plan.
4.2
Emergency Action Plan

The Emergency Action Plan (EAP) is a comprehensive, country-specific resource for
planning and managing non-medical emergencies that may impact Volunteer safety.
An EAP may cover such non-medical emergencies as natural disasters, civil unrest,
political uprisings, and environmental catastrophes.
The Country Director (CD), with the assistance of Peace Corps staff and the
American Embassy, is responsible for developing, testing and periodically reviewing
the EAP. The PCMO typically participates as a member of the emergency planning
team.
Peace Corps Manual Sections (MS) 270 Volunteer/Trainee Safety and Security and
350 Emergency Action Plans provide guidance on the development of an EAP.
5. THE MEDICAL EVACUATION PLAN

The Medical Evacuation P lan is a reference document for PCMOs and a resource for other
providers and staff who may not be familiar with the medevac process.
The contents of a Medical Evacuation Plan should be organized in a notebook that is
prepared by each post. The PCMO is responsible for insuring that the medevac plan is
current and available to all individuals who may participate in a medical evacuation.
Frequently, the medevac plan contains information on accessing Volunteer medical records
and medical supplies, therefore, it should be stored in a secure location.
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5.1
Organization and Contents of the Medical Evacuation Plan

While the exact content of a Medical Evacuation Plan is specific to each post, each
plan should include the following information:
M EDICAL E VACU AT ION PL AN CONT ENT S
1. Medevac Procedures
Medevac checklist for the PCMO, CD and Director of Management Operations (DMO)
(see ATTACHMENT B)
TG 380 Medical Evacuation;
Peace Corps Manual Section (MS) on Medical Evacuation;
2. Emergency Contacts
OMS, including after-hours duty officer contact information;
Peace Corps staff, e.g. CD, DMO, Regional Medical Officer (RMO);
U.S. Embassy staff to include Duty Officer, Administrative Officer;
Local and regional ambulance services;
Local and regional hospitals;
Local and regional emergency providers, e.g., cardiologist and general surgeon;
Local and regional laboratories, e.g., emergency blood typing, HIV testing;
Local and regional emergency radiology facilities, e.g., ultrasound, CT scan;
Maps to important medical locations.
3. Volunteer Contact Information
Volunteer Emergency Locator Forms (see ATTACHMENT A);
Volunteer telephone numbers and addresses;
Maps to Volunteer sites.
4. Communication Systems
Sample medevac field consult;
Sample medevac estimated time of arrival (ETA) fax or cable;
Instructions for use of in country communications services, e.g., government, NGO,
missionary, and police radio networks;
Instructions for use of cell phones, pagers, beepers, and hand-held radios.
5. Transportation Systems
Procedures for emergency use of the Peace Corps vehicle;
Local ambulance services;
Airline schedules;
Government and military services for helicopter and charter aircraft;
Train and bus schedules;
Taxi services;
Contact information for airport security, customs officials, and immigration officials.
(continued)
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6. Emergency Air Rescue

TG 385 Emergency Medical Evacuation;
Contact information for medical evacuation and rescue services in country, to include
description of services and recommendations for use;
Contact information for international air rescue services;
Procedures for obtaining clearance for the use of the local airports by air emergency services;
Procedure for obtaining permission to take an ill Volunteer on a commercial aircraft;
Military Services: telephone numbers, addresses, contact information, and procedures for use.
7. Emergency Transfusion Procedures
Contact information for facilities and providers competent to perform emergency blood or
blood products transfusions;
U.S. Embassy walking blood bank procedures, if applicable;
Lists of Volunteers, staff and others and their blood type.
8. Emergency Supplies and Equi pment
Location of emergency supplies and equipment;
Instructions for access to the health unit, supply room and emergency pharmaceuticals.
9. Volunteer Evacuee Documents
Pre-departure instructions for medically evacuated Volunteer;
Copy of Welcome to Washington;
Instructions for access to Volunteer Health Record, WHO card, Health Benefits identification
card, passport.
10. Accompaniment Documents
Accompaniment MS;
Accompaniment procedures and responsibilities (see section 9).
11. Administrative and Fiscal Information
Instructions for using medical funds;
Cash advance and petty cash;
Form PC-477: Certification of Non-Indebtedness and Accountability for Property;
Power of Attorney form;
Release of Medical Information.
12. Regional Medevac Procedures
Instructions for sending a Volunteer to a regional medevac destination;.
Contact information at the regional location;
Regional medevac checklist for the PCMO.
5.2
Sources of Information
Useful sources for developing or updating a Medical Evacuation P lan may include:
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5.3
Country Director
Administrative Officer (DMO)
Peace Corps staff
Volunteers
Local medical societies
Local fire department
U.S. Embassy
Other foreign embassies and consulates
Non-Government Organizations (NGOs)
International business organizations
Medical universities and teaching hospitals
Red Cross
Annual Review of Medical Evacuation Plan

The PCMO should update the Medical Evacuation P lan periodically to ensure that the
document is accurate and current. The PCMO should document the date(s) of the
annual review(s) in the plan.
Additionally, the PCMO should review the Medical Evacuation P lan annually with the
CD, DMO, and support staff who may be involved in a medevac, e.g., health unit
support staff, drivers, and translators. The purpose of this review is to educate Peace
Corps staff on the medevac process and ensure their participation as necessary.
5.4
Volunteer Emergency Site Locator Forms

The purpose of the site locator form is to assist the PCMO and the country staff with
locating a Volunteer in a medical or non-medical emergency. Forms should contain
contact, transportation, and communication information for the Volunteer including a
detailed map and directions to the Volunteer's home, work site, and nearest medical
facility. Volunteers should update the site locator form whenever the basic information
changes.
Every Volunteer should complete a Site Locator Form. MS 270 Volunteer/Trainee
Safety and Security states that the CD is responsible for establishing procedures to
ensure that site locator forms are revised and updated when necessary.
There is no Agency format or template for a site locator form. A sample site locator
form is included in ATTACHMENT A. The CD, together with the country staff, is
encouraged to develop a site locator form that meets the specific needs of the post.
The PCMO must have direct access to the site locator forms, either in the Medical
Evacuation P lan, or in another readily accessible location.
6. MEDEVAC DECISIONS
The decision to medevac a Volunteer to the U.S. is made by OMS, in consultation with the
PCMO and Regional Medical Officer. The decision to medevac a Volunteer to a regional
medical evacuation site is made by OMS, or the RMO in consultation with the PCMO.
PCMOs should inform OMS of all RMO medevac decisions.
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This section describes standard procedures for the initiation, coordination and administration
of a medical evacuation.
6.1
Consultation
Medevac consultation is the dialogue between OMS and the PCMO in a setting
where medical evacuation is under consideration.
OMS consultation is required for medical evacuation to the U.S. OMS

consultation, or RMO is also required for medical evacuation to a regional
evacuation site or other non-U.S. site except where medical evacuation is a part of
routine health unit operations, e.g., routine access to medical or dental care in an
adjacent country.
Consultation may occur by cable, fax, or telephone and should include the
following information:
6.2
Volunteer's name, date of birth (DOB), social security number (SSN), and
Close of Service (COS) date;
Case summary in SOAP note format;
Anticipated time frame for medevac;
Transportation requirements;
Accompaniment requirements;
Special considerations.
Volunteers being medically evacuated often have medical problems other than the
condition necessitating the medevac. If these conditions require evaluation and
treatment beyond the scope of care available through the Peace Corps health unit,
the PCMOs should include this information in the medevac consultation
communication.
Concurrence
Medevac concurrence is the outcome of a medevac consultation that results in the

decision to medically evacuate.
OMS concurrence is required for medical evacuation to the U.S. OMS

concurrence or RMO concurrence is also required for evacuation to a regional
medical evacuation site or other non-U.S. site except where medical evacuation is
a part of routine health unit operations, e.g., routine access to medical or dental
care in an adjacent country.
Upon concurrence, the PCMO, RMO and OMS will determine the following:
Degree of urgency of the medevac;
Necessary pre-travel assessment and/or stabilization measures;
Transportation requirements, e.g., en route monitoring, wheel chair transport;
Need for accompaniment.
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6.3
OMS concurrence may occur by cable, fax, or telephone.
Authorization
Medevac authorization is the assignment of a MS (Medical Services) reference

number by OMS authorizing the use of funds for medevac travel.
Authorization is required for medical evacuation to the U.S. Authorization is not

required for medical evacuation to a regional medical evacuation site or other nonU.S. site.
If required, the authorization reference number will be included in the OMS

concurrence communication.
In the rare event where OMS or the RMO cannot be contacted in a timely fashion,
the PCMO may unilaterally authorize an urgent medevac. The PCMO should
promptly notify the CD in this situation.
M EDEVAC DECISIONS : SUM M ARY
Medevac Destination
OMS or RMO
Consultation
OMS or RMO
Concurrence
OMS Authorization
U.S.
Required
Required
Required
Regional Evacuation
Site and Other NonU.S. Sites
Required
Required
Not Required
(except w hen medical

care in an adjacent
country is part of routine
health unit operations).
(except w hen medical

care in an adjacent
country is part of routine
health unit operations).
7. MEDEVAC COMMUNICATIONS
Effective communication is essential for the timely management of a medevac. During the
medevac process, the PCMO will need to communicate with the Volunteer, Peace Corps staff,
local providers, local communication and transportation services, and OMS.
7.1
In-Country Communications Services

The PCMO is responsible for assessing local communications services capable of
providing routine and emergency assistance to Peace Corps. Most Peace Corps
countries have telephone and telegraph services in the capitol. The reliability of these
services, as well as availability of extended service outside the capital, varies by
country. Some countries have the ability to communicate via military, government,
NGO, missionary, and police radio networks. The PCMO should be familiar with, and
know how to access, these services prior to an urgent medical event.
7.2
Cell Phones, Pagers, Beepers, Radios
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Post is required to establish 24/7 access to the PCMO or a qualified medical provider
in order to ensure 24-hour emergency medical assistance for Volunteers. The
emergency contact system varies by country and availability of services. PCMOs may
carry cell phones, pagers, hand-held radios, or other devices that allow immediate
contact. Where communications services are severely limited, some counties may
provide Volunteers with cell phones or other communication devices.
7.3
Communication with OMS

Communication between the PCMO and OMS regarding medical evacuation should
be conducted through the International Health Coordinator (IHC) (see section 6
above). See also TG 370 Field Consultation and Communication for detailed
information on communications with OMS during a medical evacuation.
7.4
Country Director and Administrative Officer Notification

The PCMO is required to notify the CD and the DMO upon OMS concurrence to
medevac. Notification should include the name of the Volunteer, the departure
information and specific transportation requirements. See section 9 below for the CD's
role in medical and non-medical accompaniment.
The PCMO is also encouraged to give the CD and the DMO preliminary notice when
medical evacuation of a Volunteer is likely or under active consideration.
7.5
Family/Parental Notification
Consistent with the Privacy Act and principles of medical confidentiality, OMS will
not, in general, notify family members or discuss the medevac with family members
unless permission from the Volunteer has been obtained.
The PCMO should determine the Volunteer's wishes regarding notification of
immediate family members. If the Volunteer wishes to notify his or her family
members, this should be done in country prior to the Volunteers departure.
Additionally, the IHC or the Medevac Coordinator at the regional site will discuss
family notification during the Volunteers medevac orientation at the medevac site.
The Volunteer may request that specific aspects of his/her current circumstances be
communicated or specifically withheld from family members. In general, the
information given to family members will be limited to pertinent facts associated with
the Volunteer's present condition.
The determination to notify family members in a serious or life-threatening situation,
where a Volunteer is incapable of providing consent, is made by OMS. Notification is
made to the individuals whom the Volunteer designated in writing for notification in
case of emergency (see TG 150 Confidentiality). PCMOs should consult OMS in
this situation.
7.6
Final OMS or Regional Medevac Coordinator Notification
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The PCMO should send a final notification fax or cable to OMS or the medevac
coordinator at the regional destination when evacuation plans, transportation
arrangements, and other medevac logistics are final. This communication should
include the following:
Volunteer name, DOB, and SSN;
A brief statement of the reason for the medevac;
Flight schedule to include ETA and all transfer points.
8. MEDEVAC TRAVEL AND TRANSPORTATION

Decisions about the method of transportation for a medevac are made by the PCMO and RMO
in consultation with OMS. Considerations when making transportation decisions include the
medical condition; health, safety, and comfort of the Volunteer; convenience; scheduling of
appointments; availability of Peace Corps vehicles and cost.
8.1
In-Country Transportation Services

Understanding local transportation systems in Peace Corps countries is essential for
the safe and efficient management of an ill or injured Volunteer. The PCMO should be
familiar with, and know how to access, these services prior to an urgent medical event.
The following transportation systems are available in most Peace Corps countries:
Airline, Train, Bus, and Taxi Transportation
The PCMO may use local airline, train, bus, and taxi transportation systems to
transport an ill or injured Volunteer.
Local Ambulance Services
Local ambulance service is available in many Peace Corps countries and may be used
for transporting an ill or injured Volunteer. The PCMO should consider the following
when using local ambulance services:
Hours of operation;
Method of contact;
Availability of emergency equipment and medications in the ambulance;
Qualifications of ambulance crew;
Distance ambulance is willing to travel away from its base;
Ability to travel to remote Volunteer sites;
Reliability, e.g., is the vehicle frequently disabled from mechanical or fuel

problems;
Method of payment, e.g., cash at the time of transport.
Government, Military, Helicopter, and Charter Aircraft Services
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Local government, military, and charter aircraft services are available in some Peace
Corps countries and may be used to transport an ill or injured Volunteer. Often these
organizations have various aircraft, e.g., helicopters that can be used to transport
Volunteers from remote sites.
Airport Security, Customs, and Immigration
The PCMO should be aware of security, customs and immigration procedures prior to
an urgent medical event. Airport security officials, customs officials, and immigration
officials are integral components of the evacuation process and post is encouraged to
develop relationships with these individuals.
8.2
Emergency Use of Peace Corps Vehicles

Peace Corps vehicles are frequently used to transport an ill or injured Volunteer. MS
522 states:
Each post is responsible for ensuring that on-call medical personnel
have safe, reliable, and reasonably quick transportation available to
them in order to respond to medical emergencies. Each post must
ensure that at least one vehicle is available in the car pool at all times
for necessary medical treatment of Volunteers. The vehicle reserved for
this purpose must be appropriate for transporting sick or injured
Volunteers given local road conditions.
The PCMO should review the Peace Corps vehicle use policy and post-specific
emergency use procedures with the CD prior to an urgent medical event. The CD,
together with the PCMO, is responsible for establishing a system of use consistent
with Agency policy. Considerations when developing a system of emergency vehicle
use include:
Vehicle access (24-hour access);
Need for a driver (24-hour access and method of contact);
Need for a translator;
Need for medical accompaniment;
Emergency equipment and medications (stretcher, back board, stiff cervical collar,
head stabilization equipment);
Need for seat removal to accommodate backboard or stretcher;
Travel documents (license, special permits, visas, proof of insurance).
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8.3
In-Country Medical Travel

In-country Volunteer travel for medical evaluation is authorized by the PCMO. Except
in extraordinary circumstances, Volunteers should contact the PCMO for authorization
prior to in-country medical travel and prior to seeking in-country health care.
Medical judgments concerning transportation and accompaniment of a Volunteer from
site to the Peace Corps health unit or another medical facility are also the
responsibility of the PCMO and should be determined prior to travel. If the Volunteer
is stable, it may be advisable for the PCMO to remain at the Peace Corps office to
coordinate the evaluation and/or evacuation process. If the Volunteer is unstable, the
PCMO should appoint an appropriate medically qualified individual to accompany the
Volunteer or personally travel to the Volunteer to provide transportation and
accompaniment support.
8.4
Medevac Travel from Post to the Medevac Destination

The majority of non-urgent medevaced Volunteers travel without accompaniment
from post to the medevac destination in economy class on scheduled commercial
airline flights. Some medevacs may require additional medical support during travel.
The PCMO, in consultation with OMS or the RMO, should determine if any of the
following special arrangements are needed:
Business or First Class seating;
Commercial transport via stretcher;
Wheelchair, stretcher, or ambulance support at departure, transfer, or arrival air

terminals;
IV fluids, medications or other medical care en route;
Medical or non-medical accompaniment (see section 9 below);
Emergency air evacuation (see TG 385 Emergency Medical Evacuation).
Commercial airlines generally require authorization to transport an individual

requiring stretcher transport or medical care en route. The PCMO should be aware of
the requirements of airlines that serve common routes to medevac destinations.
9. MEDEVAC ACCOMPANIMENT
The policies for medical, non-medical and spouse accompaniment are outlined in MS
264.4.2.6 Accompaniment and MS 264.4.2.7 Accompaniment by V/T spouses,
Dependents, and Parents of Dependents. Medical judgments concerning the need for
accompaniment and the type of accompaniment required are determined by the PCMO in
consultation with OMS.
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9.1
Indications for Accompaniment
9.2
Medical accompaniment is indicated when a Volunteer requires:
Continuous medical monitoring, e.g., vital signs, observation of symptoms;
Medical care en route, e.g., IV fluids, oral or parenteral medications, pain

management;
Physical restraint or control, e.g., psychosis.
Medical or non-medical accompaniment may be indicated when a Volunteer

requires:
Support for significant physical discomfort;
Supervision, e.g., alcohol abuse;
Extraordinary emotional support, e.g., assault victim;
Physical or logistical assistance, e.g., aid ambulating or assistance passing

through immigration and customs.
Type of Accompaniment
There are three categories of Peace Corps-authorized medevac accompaniment:
1. Medical Accompaniment
The PCMO, in consultation with OMS, determines that the medical condition of the
Volunteer requires accompaniment by a medically qualified individual. In these cases
the PCMO determines the most appropriate individual to accompany the Volunteer.
The PCMO should promptly notify the CD of these determinations so that post can
consider staffing and program needs. The most common medically qualified
accompaniments are the PCMO, a medical assistant, or a Peace Corps medical
consultant.
Medevacs that have been sexually assaulted or injured may require a same sex
accompaniment. Medevacs with a presumed or confirmed mental illness associated
with potential suicide may require same sex or a two-person accompaniment.
2. Non-Medical Accompaniment
The PCMO, in consultation with OMS, determines: (1) that the medical condition of
the Volunteer requires monitoring or support during travel; and (2) that monitoring
may be by a non-medically trained person. In these cases the PCMO, in consultation
with the CD, determines who will accompany the Volunteer. The accompaniment may
be a spouse, a staff member, or another Volunteer.
In extraordinary circumstances, a Volunteer may provide non-medical accompaniment
to another Volunteer. In general, this is only appropriate when the basis for nonmedical accompaniment is the need for physical or logistical assistance. As with other
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non-medical accompaniment, the CD must determine that a Volunteer may provide

accompaniment to another Volunteer.
3. Spouse Accompaniment
The PCMO determines that spouse accompaniment is advisable from a medical
perspective. This generally occurs in situations involving major surgery or lifethreatening conditions. Occasionally, the PCMO may determine that spouse
accompaniment is medically advisable when the stress associated with separation from
the spouse would significantly affect the medical condition of the Volunteer. Spouse
accompaniment may be appropriate in addition to the concurrent need for medical
accompaniment. Members of a Volunteer's immediate family may serve in this role.
M EDEVAC ACCOM P ANIM ENT SUMM ARY
Type of Accompaniment
Determines the Need for

Accompaniment
Identifies the Person to

Provide Accompaniment
Medical
PCMO
(in consultation with OMS )
PCMO
(with CD notification)
Non-Medical
PCMO
(in consultation with OMS)
PCMO
(in consultation with CD)
PCMO
PCMO
Spouse
(medically indicated)
Unauthorized Accompaniment:
In certain situations a medically evacuated Volunteer may be traveling with a friend,
significant other, or spouse who has not been designated or authorized as a medevac
accompaniment under one of the four authorities described above. In these situations,
the individual traveling with the medically evacuated Volunteer is not on official
travel and is responsible for all expenses and arrangements associated with his/her
travel, e.g., lodging.
9.3
Responsibilities of the Accompaniment

The PCMO must ensure that the person providing accompaniment is fully informed
about the medevac process and the responsibilities of their assignment.
Responsibilities of Medical and Non-Medical Accompaniments include:
Attention to the Volunteers comfort level and needs.
Logistical coordination. The individual providing accompaniment must have all

relevant information on:
Flight departures, arrivals and transfers;
Arrival arrangements such as stretcher or wheelchair transfers;
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Contact information at final destination, e.g., transfer to emergency room,

other medical facility, hotel arrangements, field support staff and OMS duty
officer contact information.
Transport of the Volunteer's health record. The health record must be hand-carried,
safeguarded and delivered to OMS staff.
Maintain medical confidentiality regarding the Volunteers illness.
Responsibilities of Medical Accompaniment may include:
9.4
Monitor vital signs, patient signs and symptoms, adverse reactions to medications
or other therapies.
Administer oral, IV, IM or other medications as indicated.
Pain management.
Restraint or close observation of a Volunteer who may be a danger to self or others

or who is not competent to manage his/her own affairs.
24-hour escort and observation. Accompaniment is completed when care of the

Volunteer is transferred directly to medical staff at a hospital, clinic, physicians
office or to the field support staff in OMS.
Document en route medical monitoring, treatment and other relevant information

in the health record.
Provide an oral report to the IHC on the first business day after arrival.
Responsibilities of Post to the Accompaniment

Post is responsible to the Accompaniment for the following:
All costs associated with official accompaniments.
Authorizing recuperation and other benefits consistent with Agency policies and
the Foreign Affairs Manual (FAM), i.e., authorizing per diem, miscellaneous and
incidental expenses (M&IE), lodging, etc.
Determining the length the stay for accompaniments at the medevac destination.
If the accompaniment is a family member, post should determine the length of stay in
consultation with OMS. In general, family member accompaniments who are
Volunteers are expected to return to country when the patients health status is no
longer serious and the CD determines that programmatic needs outweigh the
emotional needs of the patient.
10. ADMINISTRATIVE SUPPORT FOR MEDICAL EVACUATION

The PCMO and the DMO collaborate on many aspects of administrative support for a
medevac.
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The PCMO is primarily responsible for ensuring that all necessary and appropriate medical
care is provided in a timely and efficient manner. The DMO is responsible for providing the
necessary administrative support to accomplish these tasks.
DMOs should reference the Overseas Financial Management Handbook (OFMH), Trainee
and Volunteer Medevac and Emergency Leave for detailed information on DMO
responsibilities in the medical evacuation process. In the FY 99 edition, this information is
found on pages 233-36.
ADMINISTRATIVE RESPONSIBILITIES DURING A MEDEVAC

PCMO
Prepares Volunteer health record.

Provides supply of medications.
Prepares WHO card
PCMO and DMO

collaboratively
DMO
Review medical coverage during medevac.

Ensures Volunteer has Health Benefits identification card.
Provide a Volunteer briefing.
Complete a Medevac checklist.
Prepares personal documents, e.g., passport, visas.
Arranges transportation.
Issues Travel Authorization (TA).
Provides cash advance.
Completes necessary paperwork:
- PC-477 Certification of Non-Indebtedness and
Accountability for Property;
- Power of Attorney;
- PC 1485 Release of Medical Information.
10.1 Preparation of the Health Record

Until it is determined that a medevaced Volunteer will not return to country, the original
records must remain at Post. Only when the final decision has been made to medically
separate or COS the Volunteer should the original health record be sent to headquarters.
During a medevac, whether to the regional hub or to the U. S., copies of pertinent medical
information such as inservice notes, specialist reports, labs, CT/MRI films, etc. should be
given to the PCV or the accompaniment to hand carry. The copies of the record should be
placed in a sealed envelope and labeled as follows:
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Medical Eyes Only

Peace Corps
5th Floor
1111 20th Street, N.W.
Washington, DC. 20526
Or
Peace Corps
Address of regional hub
The copied health records should be given to the IHC or RMO when the Volunteer
arrives at the medevac destination.
Post will maintain the Volunteers original record and file information obtained from
headquarters or regional medevac hubs in the medevac section of the health record. If
the Volunteer does not return to country, the information should be added to the
original record before it is sent to Medical Records in OHS.
10.2
10.3
10.4
Medications
Volunteers should bring, at a minimum, a two-week supply of their malaria

prophylaxis with them on medevac. Unless specifically contraindicated, the PCMO
should instruct the Volunteer to continue malaria prophylaxis while on medevac.
Unless contraindicated, the Volunteer should bring, at a minimum, a two-week

supply of all routine medications and should be instructed to continue taking all
regular medication while on medevac.
Personal Documents Required for Evacuation
All Volunteers being medically evacuated must carry their personal passport,
visas, World Health Organization (WHO) vaccination card, and Health Benefits
identification card to the medevac destination. Local identification cards and other
forms of identification should also be carried if they are considered important
immigration documents in the host country or may be needed while on medevac.
These documents should be up to date prior to departure, and should be stored in a
location that permits both the PCMO and DMO to gain access to them in an urgent
situation.
If a passport is lost or stolen, the DMO should contact the Consular Officer at the
American Embassy and local immigration officials to assist Peace Corps with
obtaining a new passport and visa. Post should maintain a centrally located
photocopy of all passports, visas, WHO cards, and identification cards for use if
originals are lost or not available.
Medical Coverage for Health Conditions that Arise During Medevac
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TG 380
Medical Evacuation
During Peace Corps service, Peace Corps will pay for all necessary medical care for a
Volunteer who develops an illness or becomes injured while on medevac. When
medically indicated, Volunteers may remain on medevac status for a maximum of 45
days. Peace Corps will not medically separate a Volunteer who has an urgent need for
medical or psychiatric care, or an unstable medical condition (see TG 160 Medical
Separation section 3.1).
After Peace Corps service, Federal Employees Compensation Act (FECA) will cover
service-related health problems that developed while a Volunteer was on medevac.
The contracted health insurance will cover non-service related health problems that
developed while a Volunteer was on medevac. Therefore:
10.5
Volunteers do not need short-term health insurance while in the U.S. during
service.
Volunteers do need to make an active, informed decision at COS or ET about

extending the contracted health insurance beyond the first month. See TG 330
Post-Service Health Benefits and Close of Service or Extension of Service Health
Evaluations for detailed information about the contracted health insurance.
Volunteer Briefing
The PCMO and the DMO should review the entire medevac process with the
Volunteer. If the Volunteer is coming to Washington, DC, the Volunteer should be
given a copy of the Peace Corps Medevac Guide to Washington D.C., and encouraged
to read the booklet prior to arrival in Washington. The booklet is available, and can be
ordered, through the Overseas Support Division in Administrative Services
(M/AS/OSD). Prior to departure, the PCMO should ensure the Volunteer understands
the following:
10.6
Transportation logistics;
What to do upon arrival at the medevac destination;
Medical clearance policy.
Medevac Check List

PCMOs, together with the DMO, should complete a Medevac Checklist and include it
in the Volunteer's health record. There is no single Agency format or template for a
medevac checklist. A sample checklist is included in ATTACHMENT B . This
document helps insure that all tasks have been completed prior to a Volunteers
departure.
10.7
Medevac Travel
The DMO arranges all logistics associated with transportation and travel of the
Volunteer being medically evacuated and the accompaniment. This includes:
Arranges in-country air and ground transportation.
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TG 380
Medical Evacuation
Arranges transportation from post to the medevac destination, including special

arrangements if requested by the PCMO, e.g., specific seating, dietary requests,
wheelchair assistance, etc.
Issues TAs to include all necessary travel and per diem expenses for the medevac
and the accompaniment (see section 9.4 above).
Medevacs to the U.S. are issued a one-way ticket. Medevacs to a regional medevac
site may be issued either a round trip or a one-way ticket depending on the preference
of post and the regional site. Accompaniments to the U.S. or a regional medevac site
are generally issued a round trip ticket unless they have prior approval from the CD for
altering their itinerary.
Volunteers and accompaniments should be advised to: (1) retain a copy of their TA;
and (2) save receipts for all transportation lodging, tax, and other expenses. The TA
and receipts should be submitted to the Medevac Assistant in Washington, DC or
Honolulu, or to the DMO at the regional medevac site. Volunteers should contact these
same individuals if additional cash or a return travel advance is needed.
10.8
Per Diem and Cash Advances

Volunteers receive cash advances and per diem sufficient to meet their needs while on
medevac. For medevacs to Washington DC or Honolulu, per diem for the first three
days of medevac are included in the Volunteers TA. Thereafter, OMS provides the
Volunteer with per diem.
10.9
Administrative Forms
The DMO should issue all medevacs to the U.S. copies of the following completed
forms:
Form PC-477: Certificate of Non-Indebtedness and Accountability for Property

(MS 223, Volunteer Trainee Readjustment Allowances Attachment I);
Power of Attorney;
Release of Medical Information.
If the Volunteer intends to resign or will be separated from service, the following form
should also be completed:
Form PC-1485: Report of Peace Corps Service (MS 284, Early Termination
paragraph 8, 12.2 and Attachment B).
10.10 Volunteer Housing, Personal Belongings, and Pets

When circumstances permit, the PCMO should instruct the Volunteer being medically
evacuated to attend to as much personal business as possible prior to departing from
site. The Peace Corps is not responsible for a Volunteers personal effects during their
absence from site. Volunteers should consider the following responsibilities:
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TG 380
Medical Evacuation
Secure home and personal effects.
Give keys to a Peace Corps staff member or an individual that Peace Corps can
readily contact.
Pay all debts including rent and advance salaries to domestic help.
Notify supervisors of expected absence and arrange work coverage.
Arrange for care of pets.
Notify other Volunteers of absence.
Make a list of personal belongings and separate out those items to ship home
should a Peace Corps separation occur.
If a medevac results in medical separation, the Volunteer is entitled to 100 lb. (45.5
kg) of unaccompanied baggage shipped to his/her home of record (HOR). This 100 lb.
limit includes the weight of packaging materials. The DMO should instruct the
Volunteer to make a list of personal effects, preferably prior to evacuation, clearly
identifying the items he/she wishes shipped from the remainder of his/her belongings.
The list is maintained by the DMO. Volunteers are responsible for all costs of shipping
beyond the 100 lb. limit and must arrange for payment prior to shipping. Peace Corps
is not responsible for lost or stolen items. Volunteers are encouraged to purchase a
personal property insurance policy.
11. FUNDING
Funding for international medical travel and accompaniment (U.S., regional, and other nonU.S medical travel) is allocated to post budgets from the Office of Volunteer Support Centrally Managed Accounts at the beginning of each fiscal year. These funds may not be
reprogrammed for any other purpose. Additional funds for international medical travel, if
required, should be requested from the Office of Volunteer Support by the Region or the
Budget Implementation Team (BIT). Unused funds are returned to the agency. See the
Overseas Financial Management Handbook for more detailed information.
An OMS authorization number, or fiscal coding, is required for medical evacuations to the
U.S., and for any chartered or emergency air rescue authorized by OMS.
An OMS authorization number, or fiscal coding, is not required for regional medevacs or
other non-US medevacs.
Post is responsible for in-country travel expenses including those expenses for Volunteers
who are later transported outside the country.
Post is responsible for all travel expenses associated with accompaniments.
12. MANAGEMENT OF VOLUNTEERS AT THE MEDEVAC DESTINATION

While on medevac status, Volunteers can expect:
Thorough medical management of the condition for which the Volunteer was evacuated.
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TG 380
Medical Evacuation
Logistical and emotional support from OMS or the staff at the regional medevac
destination.
Evaluation and treatment of health conditions unrelated to the reasons for medical evacuation
will be evaluated by OMS, or the regional site, on a case-by-case basis. In general, PCMOs
should continue to evaluate and treat routine and on-going medical conditions in country.
12.1
Management of Medevacs in the U.S.
Arrival at the Medevac Destination

Routine medevacs to Washington, DC. proceed directly, by taxi, to a
predetermined hotel. Medevacs are not routinely met at the airport by OMS staff.
If medically necessary the medevac may be met with an ambulance or taxi and
taken directly to the appropriate medical facility. If an ambulance is required,
OMS will discuss and confirm this information with the PCMO prior to the
medevacs departure from country. Volunteers receive an information sheet at the
hotel that lists the time and location of their first Peace Corps appointment.
Accommodation, Transportation, and Per Diem

OMS provides Volunteers on medevac status in the U.S. with lodging,
transportation, and per diem. In general Volunteers receive the following: (1)
shared hotel accommodation; (2) reimbursement for all travel costs associated with
their medical care; and (3) per diem, including the cost of M&IE, for the duration
of their stay.
Medevac Orientation
All medevacs to Washington meet with the regional IHC and the Medevac
Program Specialist on the first business day after their arrival. The medical
evaluation process, appointment schedule, and relevant policies and procedures are
reviewed during this orientation. At this meeting, PC-127C Authorization of
Payment of Medical/Dental Services authorizations, which include a release of
medical information by consultants are also issued. Copies of the health record and
other case-related material are collected by the IHC from the Volunteer or the
accompaniment at this time. Copies of the health record are held and maintained
by the regional IHC throughout the medevac.
Case Management: Consultant Appointments, Evaluation, Treatment

Medical care for Volunteers evacuated to the U.S. is provided by local consultants.
The IHC facilitates and monitors the care provided to medically evacuated
Volunteers. The IHC schedules all initial medical and dental appointments,
arranges hospitalization, assists with scheduling surgery, and maintains frequent
consultations with the Volunteer's providers.
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TG 380
Medical Evacuation
Medications and Supplies

OMS reimburses Volunteers on medevac status for all medically indicated and
authorized prescription medication, non-prescription medication, and orthopedic
supplies.
Documentation and Field Status Reports

Medevac medical care is documented in the OMS Medevac Case Management
System. Case management notes and medical reports are placed in the Medevac
section of the health record prior to a medevacs return to country or prior to
medical separation.
The IHC will provide the PCMO with weekly updates on the status of all
medevacs. This update may include a brief summary of the Volunteer's recent
history, current diagnosis, treatment plan, and prognosis; or may consist of a copy
of the medevac case management notes. At the conclusion of the medevac, the
IHC or the regional site coordinator will notify the PCMO of the outcome of the
medevac, including either the return ETA information or the anticipated separation
date. Within the parameters of medical confidentiality, the PCMO is responsible
for informing the CD and the DMO of the Volunteer's status.
12.2
Management of Medevacs at a Regional Medevac Site or Other Non-U.S. Site

Medical care for Volunteers evacuated to a regional medevac site or other non-U.S.
site is provided by local consultants. In certain circumstances, the PCMO or RMO at
the regional medevac site may provide direct patient care. Health unit staff at the
regional medevac site will monitor all care rendered to Volunteers through direct
contact with the Volunteer and frequent consultations with a Volunteers care
providers.
Procedures for managing medevacs at regional medevac sites and other non-U.S. sites
vary by regional location. The medical and administrative staff at the regional site and
at the sending posts will coordinate administrative procedures for regional medevacs.
Posts should consider the following when developing regional medevac procedures:
Arrival logistics;
Accommodation, transportation, per diem;
Medevac orientation;
Management of health records;
Case management, including consultant appointments, evaluation, and treatment;
Monitoring care;
Provision of medication and supplies;
Documentation and status reports;
Medical clearance and return to country.
April 2013
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TG 380
Medical Evacuation
13. MEDEVAC POLICIES

Refer to MS 284, Section 3.0, Medical Separation and MS 220, Section 7.1, Medical
Hold for policies governing medical separation.
Volunteers may remain on medevac status for up to 45 days. The 45 day time frame begins
with the evacuee's departure from the country of assignment.
13.1
Medical Clearance
A Volunteer on medevac in the U.S. must be medically cleared by OMS to return

to post. When cleared, the Volunteer returns to post unless the:
1. Volunteer elects to resign;
2. CD initiates an administrative separation;
3. Volunteer is within 90 days of COS.
Volunteers within 90 days of COS are given an advanced COS date and do not
return to post unless the CD determines that the Volunteers absence would
adversely affect Peace Corps effectiveness in the host country (see MS 264).
13.2
A Volunteer on medevac at a regional medevac site must be medically cleared by

the providers at the regional site to return to post. When cleared, the Volunteer
returns to post only after the providers at the regional site have reviewed the case
with the PCMO at the sending post, and obtained his/her concurrence. If the
providers at the regional site and the sending post cannot reach a clear
determination on a Volunteers return to country, the providers should consult
OMS. The regional site should notify the sending post and OMS when a Volunteer
has been cleared to return to post.
Volunteers who have been medically cleared are expected to return to post
promptly. Generally, travel to post is initiated within 24 hours after medical
clearance unless the CD has authorized annual leave or absence from post.
Medical Separation
OMS concurrence is required prior to medical separation after a regional medevac.

For additional guidance see TG 160 Medical Separation.
If the regional center determines that a Volunteer's medical condition precludes

return to country the PCMO must review the case with OMS. OMS will advise as
to whether the Volunteer should return to country, receive further evaluation in the
U.S. or be medically separated in the field (see TG 160 Medical Separation).
Volunteers medically separated in the U.S. complete the COS process in the U.S.
in accordance with TG 330 Post-Service Health Benefits and Close of Service or
Extension of Service Health Evaluations. Volunteers medically separated from
post or a regional medevac site must complete the COS process in the field as per
TG 330.
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Medical Evacuation
13.3
OMS will inform post of a medical separation, including the anticipated

termination date. If the health record is in country, it should be sent to OMS
immediately via the most rapid route available, e.g., DHL.
Volunteers who have been medically separated have the right to appeal. Appeals
should be made in writing to the Director of Medical Services.
Medical Hold
PCMOs are encouraged to authorize medically necessary examinations and treatment
for Volunteers who are traveling to the U.S. on vacation, home leave or other
approved leave. A 127C authorization form is used for this purpose (see TG 340 PC127C Form Authorization for Payment of Medical/Dental Services section 3 Use
of the 127C During Service).
Prior to departure, the PCMO should inform Volunteers that they must contact OMS if
they require medical or dental attention in the U.S. beyond that previously authorized
by the PCMO. Common situations that require OMS assistance include: an acute
illness requiring medical care; evaluations or treatments recommended as follow-up to
an initial consultation authorized by the PCMO; prolonged dental interventions such as
crowns.
When a Volunteer on personal business in the U.S. contacts OMS, the IHC works with
the individual to ensure that medical needs are resolved within the allotted leave time.
The IHC monitors care through direct contact with the Volunteer and consultation
with his/her care providers. When necessary, OMS staff issues additional 127C
authorizations for medical or dental care.
If the time required for resolution of a medical problem exceeds the Volunteer's leave,
the IHC will: (1) place the Volunteer on Medical Hold at HOR or (2) have the
Volunteer travel to Washington, DC for evaluation or care.
When a Volunteer is placed on Medical Hold at his/her HOR or medically evacuated
to Washington from his/her HOR, he/she must be medically cleared by OMS prior to
return to post. Volunteers on Medical Hold are eligible for the same benefits
(excluding travel to and from post) and have the same obligations as Volunteers. The
field support staff notifies the PCMO when a Volunteer has been placed on Medical
Hold. The PCMO is then responsible for informing the CD of the Volunteers Medical
Hold status.
The field support staff maintains a record of all communication and 127C
authorizations for Volunteers on Medical Hold. This documentation is sent to post to
be included in the Volunteer's health record following the Volunteers return to
country. Volunteers are responsible for obtaining copies of their medical reports for
care received at their HOR and bringing them back to country to be included in their
health record.
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TG 380
Medical Evacuation
14. MEDEVAC SURVEILLANCE

The PCMO reports all regional medevacs to OMS in the Country-Sponsored Medevac
Form: (see TG 430 Case Notification section 3 Reporting of Country-Sponsored Medical
Evacuation).
The PCMO reports all medevacs, regional and U.S., to OMS in the monthly epidemiological
surveillance report (see TG 410 Epidemiological Surveillance System).
15. MINIMIZING THE THROMBOEMBOLISM RISK DURING MEDEVAC

Prolonged immobility and venous stasis associated with long-haul flights are the major
promoting factor for venous thromboembolism. Risk increases with duration of flight (more
common in flight of >12 hours duration, whereas rarely occurring in flights of <4 hours
duration). Compression of the popliteal vein at the edge of a seat and hemoconcentration
associated with diminished fluid intake and increased insensible water loss may serve as
additional risk factors.
The risk of venous thrombosis is very low in travelers without pre-existing additional risk
factors. These additional risk factors include age above 50 years, clotting disorders,
cardiovascular disease, malignancy, recent major surgery or trauma, history of deep venous
thrombosis or pulmonary embolism, pregnancy, and use of oral contraceptives. Smoking,
obesity, and varicose vein may serve as additional risk factors.
Traveler's thrombosis is a potentially preventable hazard of air travel. Preventive efforts are
largely focused on stimulation of circulation to prevent venous stasis. Most travelers are at
low risk and only need to follow nonpharmacologic measures listed below.
A pharmacological measure should be used in individuals at highest risk such as malignancy,
personal history of venous thromboembolism, recent major orthopedic surgery, or trauma,
unless a contraindication is present. Single dose of low-molecular-weight heparin 2 to 4 hours
before long-haul flights results in a significant reduction in risk of traveler's thrombosis.
The PCMO should consider the risk of thromboembolism for all Volunteers being medically
evacuated and use appropriate measures to minimize the risk of thromboembolism in
consultation with OMS.
Measures to minimize risk of traveler's thrombosis

Nonpharmacologic
1. Bulkhead seating if available.
April 2013
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TG 380
Medical Evacuation
2. Avoid constrictive clothing.

3. Take periodic walks during the flight.
4. Simple, frequent, isometric calf exercises, such as flexion and extension of foot and
ankle rotation exercises.
5. Change positions periodically while seated.
6. Avoid leg crossing.
7. Maintain adequate hydration.
8. Avoid excess alcohol and caffeine-containing drinks because they may cause
dehydration.
9. Do not place hand-luggage where it may restrict movement of legs and feet.
10. Get off plane and walk around in air terminal at refueling stops.
Pharmacologic (may be considered for high-risk individuals)

1. Aspirin: caution in patients with peptic ulcer disease or history of gastrointestinal
bleeding.
2. Low-molecular-weight heparin.
i.e., Enoxaparin sodium, 30 - 40 mg, via subcutaneous injection
April 2013
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TG 380 ATTACHMENT A
EMERGENCY SITE LOCATOR FORM

This form is required to ensure that in the event of an evacuation or medical emergency Peace Corps can contact
and, if necessary, locate you.
INSTRUCTIONS: Please complete this form and return it to the Peace Corps Medical Officer within 30 days of your arrival at
site. Please provide complete information utilizing your host institution, counterpart, and host family to obtain the information
requested. When your contact information, housing, or site assignment changes; it is your responsibility to ensure that an upto-date form is on file with the Peace Corps Health Unit
Name:
DOB:
Location of Passport (if kept at site):

A. VOLUNTEER CONTACT INFORMATION
1) Home address, telephone number, location of nearest telephone and proprietor:
2) Work address and telephone number:
B. COUNTERPART, HOST FAMILY, OTHERS CONTACT INFORMATON

3) Counterpart name, address and telephone number:
4) Host family name, address and telephone number:
5) Contact person at site willing to go to your home in an emergency; name, address and telephone number:
6) Name, address and telephone number of the Volunteer who lives closest to you:
C. MEDICAL FACILITIES AND OFFICIALS

7) Name, address and telephone number of nearest emergency medical facility:
8) Name address and telephone number of local physician:
9) Name address and telephone number of Chief of Police, police station, or security official near your site:
Page 1
TG 380 ATTACHMENT A
D. TRANSPORTATION AND COMMUNICATION

10) Methods of transportation to the capitol available at site including procedures for use.
11) Communication options available at site including procedures for use, i.e., availability, hours.
12) Name and contact information for nearest airport or landing strip. Specify small or large aircraft capacity.
E. EMERGENCY CONTACT IN THE U.S.

13) Name, address and telephone number of person to notify in case of an emergency. Please specify parent,
family member, or other.
F. MAP OF YOUR RESIDENCE, WORK SITE, AND NEAREST MEDICAL FACILITY

Please use the space below or the back of this sheet to draw a detailed may to your site. Indicate the location of your
residence, work place, and nearest medical facility. Indicate north on your map and use descriptions and landmarks
that would assist us in locating you.
Date Last Revised:
_________
Date Last Revised:
_________
Date Last Revised:
_________
Date Last Revised:
_________
Page 2
TG 380 ATTACHMENT B
MEDEVAC CHECK LIST

Name:
DOB:
Medevac Date:
COS:
Accompaniment: Y __ N __ Accompaniment Name:
Name and contact information of family member or next of kin:

Forwarding address:
1. HEALTH OFFICE
o
o
Medevac field consult sent; VS concurrence and/or authorization number received.

Itinerary and ETA sent to VS or regional medevac site.
To Volunteer:
o
o
o
o
o
o
o
Health record in sealed envelope addressed to VS

X-rays and pertinent diagnostic studies
Two week supply of routine medications and malaria prophylaxis, if indicated
WHO vaccination card
Health Benefits identification card
Medevac instructions
Explanation of medical separation and medical clearance policies
PCMO Signature
2. ADMINISTRATIVE OFFICE
To Volunteer:
o
o
o
o
o
Transportation from post to medevac site, i.e., airline ticket, transportation to airport
o
o
o
o
Form PC-477: Certificate of Non-Indebtedness and Accountability for Property
Travel Authorization (TA)

Passport and visas
Cash advance and per diem
Prepare final termination document and explain any deductions that will be made from the Readjustment
Allowance for overpaid living allowance, leave allowance, or other indebtedness
Power of Attorney form signed by Volunteer
Release of Medical Information form signed by Volunteer
Explanation of personal effects shipment policy, i.e., weight limits, personal property insurance. Review
status of personal belongings left in country, i.e., secure, itemized list received?
Administrative Officer Signature
3. COUNTRY DIRECTORS OFFICE
Description of Service: Report of Peace Corps service completed if Volunteer intends to resign or be
separated from service
Authorizations for leave or vacation following medical clearance
Country Director Signature
VS/TG 380 Attachment A/Revised November 2010
Peace Corps
EMERGENCY MEDICAL EVACUATION
1. PURPOSE
To establish procedures for the medical evacuation of Peace Corps Volunteers and Trainees
requiring emergency medical evacuation (medevac).
2. BACKGROUND
Emergency medical evacuation is used for acute, life- limb- and organ-threatening
emergencies that require emergency medical evacuation by a chartered aircraft to ensure
timely delivery of care. Such emergencies among Peace Corps Volunteers are rare.
Nevertheless, Peace Corps Medical Officers (PCMOs) must be prepared to manage these
emergencies. In these situations, Peace Corps will request the services of an international air
rescue company or the U.S. military to evacuate the Volunteer. Emergency air evacuations
require a coordinated effort between the post, the PCMO, the Office of Medical Services
(OMS), and the air rescue company.
The telephone numbers, fax numbers, email addresses, mailing addresses, and
other contact information listed below are up-to-date as of the publication of this
Technical Guideline (TG). Posts should ensure that their contact information is
accurate and up-to-date.
3. PLANNING FOR AN EMERGENCY MEDICAL EVACUATION

TG 380 Medical Evacuation section 5.1 identifies the organization and contents of a
Medical Evacuation Plan. In order to ensure preparedness for an emergency medevac, the
PCMO should ensure that the plan is current and contains the following information:
Emergency air rescue procedures;
Contact information for in-country and international air rescue services;
Emergency transfusion procedures;
Information on access to a local trauma facility, general surgeon, and cardiologist or

internist;
Capabilities of local operating suites, intensive care units, and emergency departments;
Location of emergency medical equipment and supplies in the health unit.
The PCMO should ensure that all individuals who may participate in an emergency medevac
are familiar with emergency medical procedures.
July 2010
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TG 385
Emergency Evacuation
4. URGENT COMMUNICATION WITH OMS

OMS will coordinate the logistics of an emergency medevac. Therefore, the PCMO should
contact OMS as soon as possible by telephone when an emergency medevac is being
considered. Procedures for contacting OMS in an urgent situation are as follows:
Telephone: During business hours (7:30 a.m. to 5 p.m. eastern time, Monday through
Friday)
For urgent concerns during business hours the PCMO should contact field support
directly through the main OMS switchboard (202-692-1500). When calling the OMS
switchboard, PCMOs should identify themselves, state the urgency of the call, and state
with whom they would like to speak. The administrative assistant who answers the
telephone will ensure that the call is transferred to the appropriate OMS staff.
Telephone: After business hours, weekends and holidays

For all medical emergencies and urgent concerns that arise during non-business hours,
PCMOs should contact the OMS Medical Duty Officer through the Peace Corps
answering service (301-790-4749). The Duty Officer is available at all times through the
Peace Corps answering service. When calling the Medical Duty Officer, PCMOs should
provide their name, country, a return telephone number, state the urgency of the call, and
request to speak with the Medical Duty Officer. The Duty Officer should return the call
within 20 minutes. If the PCMO does not receive a response within 20 minutes of the
call, he/she should contact the service again.
Night Action Cable (NIACT)

In the rare circumstance where telephone communication is impossible, the
Administrative Officer at post should request assistance of the American Embassy to
send a NIACT cable (Night Action Cable). The State Department will then contact the
Medical Duty Officer who will respond accordingly.
URGENT COMMUNICATION WITH OMS/OSS

During Business Hours
Contact IHC through the main OMS switchboard.

(202-692-1500)
After Business Hours

(weekends, holidays)
Contact the Medical Duty Officer

(301-790-4749)
During & After Business Hours
OSS
(202-692-1470)
If Communication is Impossible:
Under extraordinary circumstances immediate communication with OMS may be impossible.
In these circumstances, PCMOs should use their clinical judgment and all available resources
to provide necessary care to an ill or injured Volunteer. Peace Corps Manual Section (MS)
264 states that in no circumstances should a PCMO hesitate to evacuate an individual if that
is the medically sound course of action.
July 2010
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TG 385
5. EMERGENCY AIR RESCUE SERVICES

When emergency air rescue is required, OMS is responsible for contacting the air rescue
company and requesting service. Decisions concerning which air rescue company to use are
made on a case-by-case basis by OMS. Unless authorized by OMS, PCMOs should not
contact or request service directly from air rescue companies.
PCMOs should be familiar with in-country air rescue services and international air rescue
companies servicing their country.
In the rare event that communication with OMS is impossible; the PCMO may contact an air
rescue company directly. MEDEX/On-Call International is the air rescue company that is
most accessible to Peace Corps posts overseas.
Contact information for Emergency Medical Evacuation
MEDEX: 1-800-537-2029-Toll Free in U.S.
410-453-6300-Outside of U.S.
410-453-6321-Fax
On Call International: 1-800-527-0218 Toll Free in U.S.
410-453-6330- Outside of U.S.
410-453-6331-Fax
6. PCMO RESPONSIBILITES DURING AN EMERGENCY MEDEVAC

6.1
Medical Case Management

The PCMO's primary responsibility in an emergency air rescue is to provide medical
care and support to the ill or injured Volunteer, i.e., medical case management.
The PCMO is not responsible for coordinating the logistics of an emergency medevac.
The air rescue company, post administrative staff, and OMS are primarily responsible
for coordinating the logistics of the emergency evacuation process (see sections 7 and 9
below).
Stabilization of the Volunteers medical condition is an immediate priority. Emergency
air rescue services may not transport a patient who is unstable or one who may not
survive the transport. Specifically, if the effects of the flight will be detrimental to the
patient, the air rescue service may determine an emergency medevac is inappropriate.
Life saving treatment should never be delayed.
The following emergency stabilization measures may be necessary:
Start basic and advanced life support measures, including the ABCs of cardiac
and trauma life support, specifically:
Airway: ensure an adequate airway; employ airway control measures,

including intubation if necessary
July 2010
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TG 385
6.2
Breathing: ensure adequate ventilation and air exchange, including

mechanical ventilation if necessary
Circulation: check for radial, brachial, femoral or carotid pulses; ensure

adequate perfusion of vital organs, including CPR if necessary.
Stabilize back and/or neck injuries. Patients should have full head stabilization gear,
stiff cervical collar and a long backboard in place.
Control external sources of bleeding.
Start at least two intravenous access sites in all unstable patients.
Consider the need for oxygen, nasogastric tube, foley catheterization.
Control seizures.
Ensure that a complete head to toe evaluation is completed, including mental status,
neurological, cardiovascular, and trauma exams as appropriate.
If blood products may be needed, activate emergency transfusion procedures.
Immobilize suspected fractures
Obtain basic laboratory and diagnostic studies when possible and applicable, i.e.,
complete blood count, chemistry profile, toxicology and alcohol screens, arterial
blood gases, prothrombin and partial thrombin times, blood type, cross and match,
electrocardiogram, chest x-ray and other radiological studies as indicated.
Reevaluate the patient frequently, as circumstances dictate.
Field Consultation with OMS

The PCMO should contact OMS as soon as possible when emergency air rescue is
being considered or if a patient is unstable.
A field consult is required for all emergency medevacs and should be conducted by
telephone directly with OMS or through the Area Peace Corps Medical Officer
(APCMO). When calling OMS, the PCMO should have available the following
information:
Patient information, i.e., Volunteer's name, date of birth (DOB), social security
number (SSN), and Close of Service (COS) date;
Return telephone and fax number of the PCMO;
Geographic location of the ill or injured Volunteer;
Name and telephone number of local attending physician;
Name and telephone number of hospital or clinic, if applicable;
Telephone and fax number of the American Embassy;
Case summary, i.e., patient status, presumptive diagnosis, and treatment initiated;
Volunteer permission to notify parents or next of kin, to include contact name and
telephone numbers.
July 2010
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TG 385
6.3
6.4
6.5
Concurrence and Authorization
The decision to medevac a Volunteer using emergency air evacuation services is

made by the PCMO (and APCMO) in consultation with OMS.
Except in extraordinary circumstances, OMS concurrence and authorization is

required for all emergency medevacs. In general, PCMOs will receive concurrence
by telephone as soon as a decision is made.
A Medical Services (MS) reference number is not provided to post for emergency
medevacs. For accounting purposes, an MS reference number is provided to the air
rescue company.
In the rare event where OMS can not be contacted, the PCMO may authorize an
emergency medevac. The PCMO must promptly notify the Country Director (CD)
in this situation.
Country Director and Administrative Officer Notification
The PCMO should give the CD and Administrative Officer (AO) preliminary notice
when an emergency medevac is likely or under active consideration.
PCMOs must notify the CD and the AO upon OMS concurrence to emergency
medevac.
The PCMO should provide the CD and the AO with periodic updates throughout
the emergency evacuation process.
Medevac Communications
After the emergency medevac has been initiated, the coordinating physician of the air
rescue company will usually contact the PCMO to verify contact information, obtain a
more detailed summary of the case, and assess the current status of the patient. Often
the air rescue company will also contact the attending physician managing the case.
7. OMS RESPONSIBILITES DURING AN EMERGENCY MEDEVAC

7.1
Request Services from an Air Rescue Company

OMSs primary responsibility is to identify and mobilize the most expeditious and
efficient air rescue service under any set of circumstances.
OMS will provide the air rescue company with the following information:
Patient information, i.e., Volunteer's name, DOB and SSN;
Telephone and fax numbers of the PCMO;
Geographic location of the ill or injured Volunteer;
Name and telephone number of the local attending physician;
Name and telephone number of the hospital or clinic, if applicable;
Telephone and fax number of the American Embassy;
July 2010
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TG 385
Case summary, i.e., diagnosis, patients status, and treatment initiated.
Once the air rescue has been initiated, OMS will relay the following information to
post:
7.2
Verification that OMS has obtained services of an air rescue company;
Confirmation of air rescue company's intent to contact post and name of their
coordinating physician;
Medevac destination, receiving facility and attending physician at the receiving

facility;
Flight estimated time of arrival (ETA).
The OMS regional International Health Coordinator (IHC) is primarily responsible for
maintaining and facilitating communication between the PCMO, OMS, and the
physician coordinator at the emergency air rescue company, throughout the evacuation
process.
If authorized, or as appropriate, OMS will contact and maintain communications with
the Volunteers family.
7.3
Case Management
OMS will provide interim case management direction to the PCMO throughout the
evacuation process. If needed, OMS will provide case consultation and interim
management advice to local physicians.
8. AIR RESCUE COMPANY RESPONSIBILITIES

8.1
Case Management
The air rescue company, in consultation with OMS and the PCMO, is primarily
responsible for the medical management of the case. Most air rescue services have a
consulting medical advisor who will provide case consultation and interim management
advice to the PCMO and local specialists.
8.2
Transportation, Immigration, Customs

The air rescue company is responsible for all transportation and logistics associated
with air evacuation. This includes:
Transportation of the Volunteer from the in-country site of stabilization to the

airport;
Facilitating passage of the Volunteer through immigrations and customs;
Transportation of the Volunteer from country to an appropriate medevac destination

and receiving facility.
July 2010
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TG 385
Post staff involved with an emergency medevac should be prepared to assist the air
rescue company in obtaining the following logistical information. Posts should be
familiar with this information prior to an emergency medevac situation.
8.3
Local airport facilities, e.g., hours of operation, length of runway, runway surface,
availability of night lights.
Flight permission and landing rights, e.g., procedures for obtaining airspace,
immigration, and landing rights. Assistance from the U.S. Embassy may be
required if local government permission to land is required.
Landing fees, e.g., required landing fees at the national airport, required method of
payment.
Local refueling procedures, e.g., availability of aviation fuel, approximate cost of

refueling a small Lear jet, method of payment. Lear Jet 55 ambulance version and
Lee Jet 35/36 are the most common aircraft used by air rescue companies.
Ambulance protocols, e.g., procedures for getting an ambulance and attendants onto
the runway.
Medevac Site and Receiving Facility

The air rescue company, in consultation with OMS, determines the medevac
destination and the receiving facility. They communicate directly with the receiving
facility to identify an attending physician and organize reception of the Volunteer.
The responsibilities of the air rescue company generally end when the Volunteer is
admitted to the receiving facility. At the request of OMS, the air rescue company will
monitor a patient on a daily basis until services are discontinued.
In general, Volunteers evacuated to a medevac destination other than the U.S. are
further evacuated to the U.S. when stable.
8.4
Flight Personnel and Equipment Requirements

The air rescue team, in consultation with OMS and the PCMO, determines the medical
personnel and skill requirements of the flight crew, e.g., surgeon, anesthesiologist,
nurse, etc. They also determine the type of equipment needed in transport, e.g., oxygen,
medications, life support systems, etc.
8.5
Accompaniment
Medical judgments concerning the need for accompaniment and the type of
accompaniment are made by the air rescue company. Space on air rescue aircraft is
frequently limited and accompaniments cannot be accommodated.
8.6
The air rescue company is responsible for maintaining communications with the post,
the PCMO, and OMS throughout the air evacuation process.
July 2010
Page 7
TG 385
In general, after the emergency medevac has been initiated, the coordinating physician
of the air rescue company will contact the PCMO to verify contact information, obtain
a more detailed summary of the case, and to assess the current status of the patient.
Often the air rescue company will also contact the attending physician managing the
case.
The air rescue company will provide OMS and the post with the following information:
Medevac destination, receiving facility, and attending physician;
Flight plan, ETA and periodic arrival updates;
Type of plane, plane tail sign, plane call sign;
Name and nationality of the crew.
Following departure:
Report of patient status following initial assessment;
Report of patient status following arrival at the destination facility.
9. ADMINISTRATIVE SUPPORT
In an urgent situation, post administrative staff should make every effort to accomplish as
many administrative support tasks as circumstances and time safely allow. These procedures
are outlined in the table below. As time permits, see TG 380 Medical Evacuation, section
10 Administrative Support for a more detailed description of medevac support procedures.
Post administrative staff is also responsible for providing logistical and communication
support during an emergency medevac. A special consideration is the Volunteers passport.
In an urgent situation, the Volunteers passport may not be in the same location as the ill or
injured Volunteer. Post should make an immediate effort to obtain the Volunteers passport
and ensure that it is available to accompany the Volunteer.
ADMINISTRATIVE SUPPORT PROCEDURES
NON-EMERGENT MEDEVAC
PCMO
Prepares Volunteer health

record.
EMERGENCY MEDEVAC
The health record is not sent with an
emergency medevac. A case summary, copies
of all case-related notes, x-rays and diagnostic
studies should be sent. The health record
should be prepared and kept at post until
requested from OMS.
As time permits.
Provides supply of
medications.
As time permits.
Prepares WHO card.

PCMO and AO Review medical coverage
during medevac.
Collaboratively
Ensures Volunteer has Health
As time permits.
As time permits.
As time permits.
July 2010
Page 8
TG 385
Benefits identification card.
As time permits.
Provide a Volunteer briefing.

Complete a Medevac checklist.
AO
Prepares personal
documents, e.g., passport,
visas.
Post should make an immediate effort to obtain

the Volunteers passport and insure that it is
available to accompany the Volunteer.
Arranges transportation.
All transportation and transportation logistics

are arranged by the air rescue company.
No TA is issued.
Issues Travel Authorization

(TA).
Provides cash advance.
As time permits.
As time permits.
Completes necessary
paperwork:
- PC-505 Volunteer
Trainee Readjustment
Allowance;
- PC-477 Certification of
Non-Indebtedness and
Accountability for
Property;
- Power of Attorney;
- PC 1485 Release of
Medical Information.
10. MILITARY FLIGHTS

On occasion, OMS may request the assistance of the Department of Defense aeromedical
evacuation units to evacuate a Volunteer. Military Airlift Command (MAC) flights are only
requested in life-threatening emergencies when no alternative to evacuation is available. In
general, MAC flights are made in cargo planes (C-141s) equipped with minimal medical
equipment. Physicians are not routinely assigned to the mission. Detailed procedures for
requesting a MAC flight are outline in MS 264.4 Emergency Military Airlift Command
Flights.
11. DEPARTMENT OF STATE

On occasion, Peace Corps may require the assistance of the U.S. Embassy Medical Unit at
post to expedite a medevac. Post should never hesitate to request the Embassys assistance if
it will improve the welfare of the Volunteer. Situations when Embassys assistance may be
necessary include:
Lost or expired passport or visa;
Customs, police or immigration issues;
Special airport privileges are needed for emergency air services;
July 2010
Page 9
TG 385
Expeditor is needed at the airport;
The Embassy medical unit staff or emergency medical supplies are required.
Most requests for diplomatic assistance should go through the Consular Officer during
working hours or the Duty Officer after hours. The Consular or Duty Officer will notify other
American officials, if necessary, including the Ambassador. Generally requests for the
Embassys assistance should come from the CD.
12. MANAGEMENT OF EMERGENCY MEDEVACS AT MEDEVAC DESTINATION

OMS, together with the air rescue company, assumes all responsibility for the Volunteer
once the emergency transport departs post. OMS will:
Monitor care of the Volunteer at the medevac destination;
Provide PC-127C Authorization of Payment of Medical/Dental Services forms for

evaluation and treatment as needed;
Guarantee payment to hospitals and physicians;
Arrange repatriation of the Volunteer to the U.S. or return of the Volunteer to post;
Discontinue services of the air rescue company when appropriate.
OMS guarantees payment for all emergency medevacs.
13. MEDEVAC REPORTING

The PCMO reports all emergency medevacs in the monthly epidemiological surveillance
report. (See TG 410, Epidemiological Surveillance System).
July 2010
Page 10
TG 385 ATTACHMENT A
SOS MEDEVAC CHECK LIST

INSTRUCTIONS: This check list outlines the responsibilities of the PCMO, the air rescue company, OMS, and post during an
SOS medevac. The checklist may be used by the PCMO and other staff to organize the multiple tasks associated with an SOS
medevac, and to assist individuals who support an SOS medevac.
Volunteer:
SSN:
DOB:
Medevac Date:
Country:
IHC:
COS:
1. PCMO RESPONSIBILITIES
Medical case management.
Obtain OMS field consultation and concurrence. Have the following information available prior to consult:
Return telephone and fax number of PCMO.
Geographic location of ill or injured Volunteer.
Name and telephone number of local attending physician.
Name and telephone number of hospital or clinic.
Telephone and fax number of American Embassy.
Case Summary.
Notify parents : Y ____ N ____ Name and contact information.
Notify Country Director and Administrative Officer of possible SOS medevac.

2. OMS RESPONSIBILITIES
Contact air rescue company. Provide post with the following information:
Verification that air rescue services have been obtained.
Name of air rescue company.
Name of coordinating physician at the air rescue company.
Medevac destination and receiving facility.
Name of attending physician at receiving facility.
Send itinerary and ETA to post.

Maintain and facilitate medevac communications between PCMO, OMS and the air rescue company.
Provide interim case management direction.
3. AIR RESCUE COMPANY RESPONSIBILITIES
Medical case management.
Arrange all transportation, immigration and customs logistics associated with the air evacuation.
Determine medevac destination, receiving facility, and attending physician at the receiving facility.
Determine flight personal, equipment requirements, and need for accompaniment.
Maintain communications with post, the PCMO, and OMS. Provide post the following information:
Medevac destination and receiving facility.

Name of attending physician at receiving facility.
Page 1
TG 385 ATTACHMENT A
Flight plan, ETA, and periodic arrival updates.

Type of plane, plane tail sign, plane call sign.
Name(s) and nationality of crew.
Following Departure:
Report of patient status following initial assessment.

Report of patient status following arrival at destination facility.
4. ADMINISTRATIVE RESPONSIBILITIES
Administrative tasks should only be accomplished as time and circumstances
safely permit. All important documents should be sealed in an envelope and given
to the Volunteer or SOS medical personnel.
PCMO
To SOS medical personnel: A case summary, copies of all case-related notes, x-rays and diagnostic
studies. The Volunteer Health Record does not accompany an SOS medevac.
Two week supply of routine medications and malaria prophylaxis, if indicated.
WHO vaccination card.
Health Benefits identification card.
Medevac instructions and While Youre Enroute to Washington D.C.
Explanation of medical separation and medical clearance policies.

ADMINISTRATIVE OFFICER
Passport, visas, other legal documents required by country for an emergency medevac.
Travel Authorization.
Cash advance and per diem.
Form PC-505: Volunteer Trainee Readjustment Allowance.
Form PC-477: Certificate of Non-Indebtedness and Accountability for Property.
Power of Attorney form signed by Volunteer.
Release of Medical Information form signed by Volunteer.
HOR address for Volunteer.
Explanation of personal effects shipment policy, i.e., weight limits, personal property insurance.
Review status of personal belongings left in country, i.e., secure, itemized list received?
COUNTRY DIRECTORS OFFICE
Form PC-1485: Report of Peace Corps service completed if Volunteer intends to resign or be separated
from service.
Authorizations for leave or vacation following medical clearance.
Page 2
Peace Corps
EMERGENCY COUNTRY SUSPENSION

1. PURPOSE
The purpose of this guideline is to provide the PCMO with information needed to safely and
effectively evacuate Volunteers from a country when Peace Corps operations are suspended.
2. BACKGROUND
Since its beginning, the Peace Corps has found it necessary on occasion to evacuate Volunteers
and staff from a country and to suspend Peace Corps operations. The evacuations have most
often occurred due to political unrest or civil war, and have generally been followed by the
indefinite suspension of the Peace Corps program in the evacuated country. On occasion,
however, a natural disaster or criminal activity has caused the Peace Corps to evacuate all or
some Volunteers from a country or withdraw Volunteers from their sites to another location in
country only to return and continue operations once the danger has passed. Evacuation Support
Guide, September 2004 (located on the intranet, Volunteer Safety and Overseas Security)
3. GENERAL CONSIDERATIONS
Emergency evacuation of a Peace Corps program during a period of unrest creates anxiety and
tension among Volunteers and staff alike. Every staff member has a multitude of tasks to
accomplish in a short period of time, so prioritizing is essential.
In preparation for an evacuation, the first step is to annually review the post Emergency Action
Plan (EAP). The EAP is a country-specific document that sets forth a detailed plan of action to
be followed by post in the event of various emergency situations, including an evacuation. See
(Peace Corps Evacuation Support Guide, September 2004).
With the decision to suspend, a transition conference is scheduled. The Country Director will
determine what information will be shared with the Volunteers regarding evacuation. For safety
reasons, it is not always possible to provide Volunteers with a full explanation of their status and
entitlements before leaving country. Volunteers should be assured, however, that their options
will be fully explained once they are all safely out of the country.
Once the evacuation decision is made, the central task is to inform and then evacuate the
Volunteers as fast and safely as possible. How that is accomplished will vary with the
circumstances; planning and decision-making at this stage requires flexibility and innovative
thinking. The EAP may not anticipate all the issues that arise. Events may be moving so quickly
that there is no time for consolidation. Missing, ill, or uncooperative Volunteers, failed
communications, unreliable modes of transportation, and unforeseen dangers are all potential
problems. For all of these events, the Close of Service (COS) health evaluations procedure is a
requirement that must be accomplished in a short amount of time and in a high stress
environment.
This TG uses the term Volunteer to refer to both Volunteers and Trainees for the purpose of evacuations.
____________________________________________________________________________________________________
September 2006
Page 1
4. OFFICE OF MEDICAL SERVICES

The Office of Medical Services (OMS) staff is an integral part of the Peace Corps process of incountry closures, evacuations and suspensions. In order to ensure a smooth transition on
evacuating Volunteers, staff and PCMOs, OMS has designated a Lead Coordinator to implement
the process. The Lead Coordinator plans and implements the medical activities of the stateside
and/or overseas transition conference for OMS. This includes representing OMS in the
headquarters transition team meetings and serving as liaison between the post, PCMO, OMS and
headquarter/regions point-of-contact personnel.
The Lead Coordinator forms an OMS evacuation team that will be sent to assist in the transition
conference either stateside or overseas. The size and composition of the team is based upon the
number of evacuees and services provided by OMS. For evacuation to the U.S., the OMS
evacuation Standard Operating Procedures (SOP) will be implemented.
5. TASKS OF EVACUATING PCMO:
PRE-EVACUATION
Participate in country evacuation meetings to assist in coordinating evacuation efforts
It is strongly urged that the PCMO accompany the Volunteers to ensure that medical
records and medications are transported properly and Volunteer medical needs are
addressed promptly
Send a complete list of Volunteers who have priority medical, mental health and
medication needs to field support nurse and/or receiving PCMO
Communicate Volunteer medical, mental health and medication needs to OMS in
Washington
If evacuation is to a third country, communicate with receiving PCMO and OMS
Ensure safe and confidential transport of Volunteer medical records (health jackets and
WHO cards)
Provide for secure retention or destruction of other records as appropriate
Prepare to take to the evacuation site stocked medical kits that include standard Volunteer
medical supplies
Give all Volunteers their own prescription medications and an adequate supply of malaria
prophylactics (if applicable)
Take sufficient supplies of controlled drugs for transition, if the PCMO is accompanying
the evacuees. If not, destroy and document waste procedure. (MS 511, Property
Management at Overseas Posts, Section 8.8, TG 200, Overseas Health Units, Section 8)
Note: If a PCMO or Medical Assistant remains at post, medications not taken on the
evacuation should be inventoried and placed in proper custody
Continue providing mental and physical healthcare to the Volunteer
ARRIVAL
Provide receiving PCMO, field support or OMS nurse with any critical information on
Volunteers upon arrival
Relinquish ongoing responsibilities for clinical care to receiving PCMO and/or OMS
nurse (for third country evacuations)
Deliver medical records to PCMO or OMS designee
Plan time for own needs; rest and closure. If available, seek support from OMS and OSS
____________________________________________________________________________________________________
September 2006
Page 2
6. TASKS OF RECEIVING PCMO: THIRD COUNTRY

PRE-EVACUATION
Assign a lead PCMO to perform COS activities and work with OMS Lead Coordinator
Prepare to receive evacuated Volunteers and coordinate care with OMS Lead Coordinator
or designee
Cancel any non-emergent appointments for in-country Volunteers and encourage those
Volunteers to remain at their sites
Develop COS interview and physical exam schedule
Contribute to a safety-oriented country information packet for arriving Volunteers by
providing information related to medical needs and tasks
Create office space to secure incoming OMS documents (COS forms) and confidential
health records. Arrange for confidential space for COS interviews and exams
Alert consultants and lab facilities regarding the possibility of services that may be
required
Coordinate with country team in planning COS conference schedule
Consult with Administrative Officer and develop a separate tracking system for
evacuated Volunteer medical supplies and visits
ARRIVAL
Assist with safety briefing--other staff may be involved
Encourage Volunteers to discuss any medical issues with onsite medical providers or
receiving PCMO
Assess medical issues and provide needed medications and/or supplies
Arrange transition of care details from Evacuated PCMO to Local PCMO/local
healthcare provider
Take report and relieve evacuating PCMO of tasks as desired or necessary
If available, utilize Office of Special Services personnel for staff and Volunteer
counseling sessions
7. THE COS CONFERENCE, INTERVIEWS AND PHYSICAL EXAMS
All Volunteers are required to attend and learn options available regarding either COS or transfer.
All Volunteers will close service with the exception of transfers (consult with region on
availability of transfers)
At the transition conference, the OMS evacuation team conducts interviews and provides
a session on post-service benefits and processes
Depending on the situation at the transition conference, either physical exams may be
done or authorizations may be given for COS exams to be performed at home of record
8. TRANSFERS
The region will decide if transfers are to be offered at the conference. The regional representative
at the transition conference will approve potential Volunteers for transfer. Medical concurrence
for these transfers is necessary from the evacuating and receiving PCMOs and/or OMS designee.
____________________________________________________________________________________________________
September 2006
Page 3
REFERENCES
Peace Corps Volunteer Safety Council, Evacuation Support Guide, September 2004
Laycock, Jane, Farmer, Bill. Evacuation Advice for PCMOs: A Fact Sheet of Suggestions, Peace
Corps, 2002.
____________________________________________________________________________________________________
September 2006
Page 4
Peace Corps
PLANNED COUNTRY/POST CLOSURE OF HEALTH UNIT
(Non-Emergency Post Closing)
1.
PURPOSE
The purpose of this guideline is to provide the PCMO with information needed to
effectively close a post health unit after the program is suspended.
2.
BACKGROUND
Once a decision has been made to close a post, there are a number of activities that
must be completed to ensure a smooth exit from the country. This technical
guideline will assist the PCMO and health unit staff with accomplishing these tasks.
3.
GENERAL CONSIDERATIONS
The areas for review and consideration when closing a health unit include
coordination of a timeline with post staff, notification of consultants, medical
facilities, laboratories, pharmacies, etc., proper disposal of medications, supplies,
office supplies, and durable equipment. This guidance will focus on each area and
list specific tasks to be performed.
Health Records
Volunteer/Trainee health records in PCMEDICS should be relinquished to OHS
in the same process as COS. Outstanding Volunteer/Trainee reports received
after the health record has been relinquished should be reviewed to assess the
need for follow-up, then, initialed and dated. Write no follow-up needed on
those that do not require further attention. Send all reports to the Post-Service
Unit via SFTP.
Vendor Notification:
Notify consultants and other vendors (i.e. pharmacy, laboratories, etc.) as soon as
possible to facilitate payment of any outstanding bills.
Medications:
Keep all medications, supplies, and equipment until the last volunteer has closed
service.
Destroy or transfer unexpired meds to the Embassy health unit or a neighboring
post (refer to MS 341: Non-emergency Post Closing, Section 7.3).
Narcotics should be transferred to the U.S. Embassy medical unit and transfer
should be done in the presence of a PCMO, CD or designee AND Embassy
medical personnel. The narcotics log should also be transferred.
Medications and supplies cannot be donated to non-US government agencies or
organizations.
Destroy all expired medications. Medications must be destroyed in the presence
of the PCMO and the CD, or designee, in accordance with local waste disposal
and air and water pollution control standards.
__________________________________________________________________________________
December 2015
Page 1 of 2
Document all medications destroyed on the Medical Supplies Disposal form, TG

240, attachment E.
Document and sign for all medications transferred on the Medical Supplies
Disposal form, TG 240, attachment E. Forward this form to the Director of OMS
through the Medical Inventory e-mail address:
medicalinventory@peacecorps.gov, and the Office of Administrative Services
through PLS: pls@peacecorps.gov. All controlled substance documents must
also be sent to the Controlled Substance Officer at PLS.
Per MS 734.10.1, all medical inventory records must be kept and available for
two years from the last entry date. Records must be disposed of in accordance
with the Guide to Peace Corps Records Schedules. Closing posts with inventory
records that have not reached their legal disposition dates should send these
records to Medical Records in OHS for storage.
Medical Supplies:
For perishable supplies with an expiration date (band aids, gauze, condoms, etc.)
offer to Embassy or neighboring post and document the disposition
If not able to transfer, document and destroy
For non-perishable supplies (exam lights, blood pressure apparatus, otoscopes,

pulse oximeters, reflex hammers, etc.) offer to a neighboring post or to the
Embassy.
Office Supplies:
Offer excess office supplies to Embassy or neighboring post
Destroy log books that contain non-narcotic documentation
Destroy outdated Peace Corps forms; send other forms to another post
Durable Medical Equipment (beds, centrifuge, exam tables, etc.):
Work with AO to coordinate auction or other property disposal method
__________________________________________________________________________________
December 2015
Page 2 of 2

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Peace Corps

Technical Guideline 300

To provide recommendations regarding the use and administration of vaccines.

Recommendations for vaccination are based on characteristics of immunobiologics, scientific

Benefits of vaccination range from partial to complete protection against the

Office of Health Services

Health Information for International Travel (The Yellow Book)

Office of Health Services

Principles of Vaccine Administration

Office of Health Services

Doses of vaccines should be given as specified in this guideline to produce

Office of Health Services

Simultaneous Administration of Vaccines

Must be given simultaneously (at two

In summary, the recommendations regarding the administration of multiple vaccines

Live vaccines and inactivated vaccines

Multiple live vaccines at the same time

Multiple live vaccines given at different times

Adverse Reactions (Side-effects)

Hypersensitivity to Vaccine Components

Office of Health Services

Vaccinations for Volunteers Traveling During and After Service

Vaccinating Febrile Patients

Office of Health Services

Live vaccines and pregnancy

Vaccine Information and Consent

Office of Health Services

The following information should be recorded in the Volunteers PCMEDICS

Name and title of the person administering the vaccine;

Date the vaccine was administered;

Vaccine lot number;

View of immunization information in PCMEDICS:

PCMEDICS Immunization Roster

Office of Health Services

6. VOLUNTEERS DELINQUENT IN RECEIVING IMMUNIZATIONS

Office of Health Services

Only adult dosages are included.

ENCEPHALITIS, JAPANESE (JE)

A serious allergic reaction after a previous dose of IXIARO is a contraindication to

No studies of IXIARO in pregnant women have been conducted. Therefore,

ENCEPHALITIS, TICK-BORNE (TBE)

Office of Health Services

Office of Health Services

Office of Health Services

Distribution and Transmission

Office of Health Services

Distribution and Transmission

Office of Health Services

Office of Health Services

Office of Health Services

Office of Health Services

Office of Health Services

Incomplete or no primary series

Office of Health Services

Office of Health Services

Office of Health Services

It should be taken at least 24 hours before or after antibiotics, sulfonamides (including

Office of Health Services

Documentation of age-appropriate vaccination:

School-aged children, adolescents, and adults: 2 doses

Laboratory evidence of immunity or laboratory confirmation of disease

has a history of anaphylactic/anaphylactoid reaction to gelatin, neomycin, or any other

Office of Health Services

Asymptomatic HIV infection and CD4 T-lymphocytes 200-499/mm3

Telephone no. () __________________

Telephone no. () __________________

Telephone no. () __________________