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3. Forms Patient Education Handout, AMSP DD2493-1, Asbestos Exposure Initial Medical Questionnaire DD2493-2, Asbestos Exposure Periodic Medical Questionnaire NAVMED 6260/5, Periodic Health Evaluation, Navy AMSP History and Physical Examination NAVMED 6260/5 History and Physical Examination Instructions NAVMED 6260/7, Periodic Health Evaluation, Navy AMSP Roentgenographic Interpretation For Pneumoconiosis (B-Reader Form) NAVMED 6260/7, Periodic Health Evaluation Instructions Physician's Written Opinion: Asbestos Medical Surveillance Program Asbestos Medical Surveillance Program Follow-Up Letter SF 600 Current Worker (Baseline, Periodic, and Termination) SF 600 Past Worker-last exposure >10 years (Baseline, Periodic, and Termination) SF 600 Past Worker last exposure 0-10 years (Baseline, Periodic, and Termination)

4. What is the AMSP? BUMED has tasked the Navy Environmental Health Center (NEHC) with centrally managing the Navy Asbestos Medical Surveillance Program (AMSP) ashore and afloat. These responsibilities include the following: 1. Providing professional and technical consultation on the medical aspects of occupational exposure to asbestos. 2. Maintaining and analyzing the central registry database containing information on personnel enrolled in the AMSP. This contains data from NAVMED 6260/5 (history and physical evaluation) and NAVMED 6260/7 (roentgenographic interpretation for pneumoconiosis). 3. Certifying equipment and technique of x-ray facilities to take AMSP chest films, and facilitating the forwarding of films for B-readings to NIOSH-certified B-readers.

5. Per OPNAVINST 5100.23 CHAPTER 17 The AMSP is designed to identify signs and symptoms of asbestos related medical conditions as early as possible through periodic medical evaluations. The program also provides for identification of medical conditions which may increase the employee’s risk of impairment from asbestos exposure and for counseling of workers on medical conditions related to asbestos exposure. 1. Criteria for Inclusion of Personnel in the AMSP. Include personnel who meet the exposure criteria defined in CFR references. These persons must remain in the program for the duration of current exposure. Civil service employees may be required to complete medical examinations related to asbestos exposure per reference OPNAVINST.

6. What are B-readers? NEHC contracts with NIOSH-certified B-readers to read all AMSP films using the ILO classification for pneumoconioses. All films must be read by the local radiologist before they are mailed for B-readings. The B-reading is designed for epidemiological purposes, not For clinical evaluation.

7. Can we take B-reader films with digital equipment? Not for Current workers, but we can for those personnel on the past worker programs.

8. And the formal reason why? In light of the recent technological advances in radiology, particularly in the area of digital radiology, many B Readers have inquired about the use of digital radiography (DR) in the classification of pneumoconioses. Questions have focused on the use of either 'soft copy' images that can be read on a monitor or 'hard copy' digital images that can be printed on film like traditional film-screen radiography (FSR). To comply with regulatory requirements under 42CFR Part 37, B Readers must continue to use standard film screen radiographs when classifying chest x-ray films for the Coal Workers' X-Ray Surveillance Program. The regulation specifies the use of film no less than 14 by 17 inches, and the use of a diagnostic X-ray machine having a rotating anode tube with a maximum of a 2 mm. source. In addition, the guidelines for use of the ILO International Classification of Radiographs of Pneumoconioses prescribe side-by-side viewing of subject and standard radiographs, and state that the standard films take precedence in defining profusion categories. Thus, until provisions for use of digital images have been specified, readers using the ILO Classification for all purposes should continue to use traditional film screen radiographs and standards.

9. Well………….. AMSP evaluations will be completed by a Occupational Medicine Physician. AMSP procedures and forms vary depending upon the patient's age, present or past exposure and time elapsed since the first exposure. Enrollment in the AMSP is based on information in References (a), (b), (c), (e), and (h). History of Asbestos exposure is documented on OPNAV 5100/15, Medical Surveillance Questionnaire/Part I, Occupational History. Current Asbestos workers require a Physicians Written Opinion.  Findings of severe respiratory impairment (FEV/FVC < 45% or FVC < 70% of predicted) or documented actual or probably asbestosis will be disqualifying of initial assignment to asbestos related duties, per reference (a). AMSP evaluation is a screening examination. A definitive diagnosis of asbestos related diseases cannot be made without further evaluation or consultation as per references (a) and (b).

10. Who is considered a CURRENT WORKER? Identified by Industrial Hygiene as “Certified” to work with Asbestos removal and be listed to “call up” for this task. The criteria for enrollment are contained in the OPNAVINST 5100.23 series. a. Military and civilian personnel who meet the exposure criteria defined in OPNAVINST 5100.23 series must be included in the AMSP and must remain in the program for "asbestos current worker" as long as the exposure criteria are met. b. An individual enrolled in the "asbestos current worker“ program must be removed from that program if he/she no longer meets the exposure criteria defined in OPNAVINST 5100.23 series. If he/she would like medical evaluation continued, he/she may be enrolled in the "asbestos past worker" program.

11. Who is considered a PAST WORKER? Through questionnaire and IH determination that any previous asbestos exposure or surveillance participation existed. This program is NOT required by OSHA or other regulatory bodies only by the United States Navy

12. So what is the English translation of all of this?

14. Current Exposure Pre-Placement/Baseline (1)     DD2493.1 Initial Medical Questionnaire (2)     NAVMED 6260/5 Periodic Health Evaluation (3)     NEHC 6260/7 B Reader X- ray Form (4)     SF 600 AMSP Medical Matrix Exam (Computer generated) (5)     DD Form 2766 (indicate date of program placement, program frequency and next due date). (6)     Spirometry (FVC, FEVs, FEV1/FVC) (7)     Physician's Written Opinion (8) OPNAV 5100/15

15. Current Worker Annual Examination (1) DD2493-2 Periodic Medical Questionnaire (2) NAVMED 6260/5 Periodic Health Evaluation (3) NEHC 6260/7 B-reader X-ray (See x-ray frequency dates next slides) (4) SF 600 AMSP Medical Matrix Exam (5) Spirometry (FVC, FEV1, FEV1-FVC) (6) Physician's Written Opinion (7) OPNAV 5100/15 (8) NAVMED 6150/20 Problem Summary Sheet (change due date)

16. Current Worker Termination (1)     Requirements are the same as for the annual examination. (2)     A termination examination is not required if the patient has received an asbestos evaluation within the past 12 months. (3) An employee being terminated from the program as a current worker is automatically enrolled in the past worker program.

17. X Ray Frequency X Rays are NOT automatically performed with each AMSP. Frequency is determined by age and time elapsed since first exposure.

18. Past Worker Initial/Baseline (a) NAVMED 6260/5 Periodic Health Evaluation (b) NEHC 6260/7 B-reader X-ray Form (c) SF 600 AMSP Medical Matrix Exam (d) NAVMED 6150/20 Problem Summary Sheet (e) Spirometry (FVC, FEV1, FEV1/FVC) (f) OPNAV 5100/15

19. Past Worker Periodic Examinations Based on age and time elapsed since first exposure (See additional slide) (a) NAVMED 6260/5 Periodic Health Evaluation (b) NEHC 6260/7 B-reader X-ray (c) SF 600 AMSP Medical Matrix Exam (d) OPNAV 5100/15 (e) NAVMED 6150/20 Summary of Care (Change due date)

20. Past Worker Termination Exam Performed on exit from Federal Civil Service. Same as Periodic. Not required if exam has been done in preceding 12 months.

21. Exam Frequency Frequency is determined by age and time elapsed since first exposure.

22. Additional Medical Record Info 1. Health Records and X-ray jackets must be prominently labeled with "ASBESTOS".   2. All forms, x-rays, correspondence, Industrial Hygiene reports, etc., which are related to the AMSP shall become a permanent part of the health record.   3. AMSP forms and documents are filed under Part III of the four-part record

23. So…..What do I do with the B-reader forms?

24. Does it matter how the forms are filled out? YES WHY YOU ASK……………. Forms received from the medical treatment facilities are reviewed and critically evaluated for legibility and accuracy. Forms are scanned into the NEHC database and must be legible. Any illegible or inaccurate data must be returned and corrected by the medical treatment facility. Quality assurance of forms is crucial in ensuring NEHC’s health physician has  accurate and valid data for performing a scientific data analysis on the records received.

25. Instructions for sending forms to NEHC Copies of both the NAVMED 6260/5 and NAVMED 6260/7 are mailed to NEHC. The address: Commanding Officer Navy Environmental Health Center 620 John Paul Jones Circle Suite 1100 Portsmouth, VA 23708-2103 Attention: AMSP Professional Support Division


27. It is A LOT of Information to learn…

28. And it take A LOT of practice!!!

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