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The AMSP Process and Protocol

Asbestos workers presenting to the MTF for medical surveillance follow MTF Asbestos Surveillance Process. After registering, NAVMED 6260/5 sections 1 and 2 are completed by the worker, weight, height, and spirometry data are entered by the staff, and the remaining information is completed by the provider. The form is copied, the original is placed in the worker's employee health record, and the copy is sent to NMCPHC at the follow address.

Asbestos Program
Navy and Marine Corps Public Health Center
620 John Paul Jones Cir, Ste 1100
Portsmouth, VA 23708-2103

(If the worker is also due for a B reading chest X-ray, the NAVMED 6260/5 is sent to NMCPHC with the authorization request, as described below.) If the form is completed electronically, it is placed in the worker's employee health record and also attached to an encrypted email and sent to usn.hampton-roads.navmcpubhlthcenpors.list.nmcphc-amsp@mail.mil. It must not be saved on the local computer, as it contains personal health information covered by Health Insurance Portability and Accountability Act of 1996 (HIPAA).

B reading protocol for workers exposed to ASBESTOS or SILICA

For workers due for a B reading chest X-ray (see NMCPHC - TM OM 6260 Medical Surveillance Procedures Manual and Medical Matrix), NAVMED 6260/7 section 1 is completed (see AMSP Forms and Instructions) by hand or using a computer, and is reviewed by MTF staff for accuracy and completeness. A single view, posterior-anterior (PA) chest X-ray is obtained and reviewed by the local radiologist. The digital image, along with the chest X-ray images of other asbestos workers at the MTF, is copied to a CD or DVD. (This is generally done by Radiology but may be done by the Occupational Health clinic, depending on local policy.) If two exposures were required to obtain the PA chest image (i.e., the person is so large that two exposures were necessary to cover the entire chest), count these two images as one chest image, and prepare one NAVMED 6260/7. As few discs as possible are to be used: There are to be no fewer than 2 images per disc (unless the MTF has had only a single X-ray in a month) and no more than 100 images per disc. Once a month or after the MTF has 100 images (whichever comes first), the MTF contacts NMCPHC for authorization, which is required to obtain a B reading.

Authorization is obtained as follows. Using this sample letter, a request is sent to NMCPHC at the above address. (The UIC in the letter is that of the MTF that is shipping the chest image CD.) Alternatively, requests for authorization to ship X-rays for B readings may be sent to NMCPHC by naval message, telefax (757-953-0670), or encrypted email usn.hampton-roads.navmcpubhlthcenpors.list.nmcphc-amsp@mail.mil.

For X-rays done as part of asbestos medical surveillance, a copy (not the original) of the NAVMED 6260/5 (the History and Physical form) must be included with the letter or fax or attached to the encrypted email. The exact number of radiograph evaluations requested is to be in the memorandum from NMCPHC. (The number of B readings is not to be estimated; the request must include the actual number of B reading X-rays that already have been done.) For silica workers, NAVMED 6260/5 is not used.

An authorized signature is required unless the request is by e-mail from a ".mil" address. If the number of B readings varies from the number on the authorization, NMCPHC is to be contacted to have the order modified before the CD (containing the image files) is shipped to the B reader. Failure to comply could result in an unauthorized procurement with funding charged to the activity.

The B reader will not make comparisons with old images. Only PA chest X-ray images, NAVMED 6260/7 forms, the authorization memo, and the mailing label are sent to the B reader. Radiology reports, other X-rays, History and Physical forms, or related information is not to be sent to the B reader. Chest X-ray images are not to be sent to NMCPHC.

All the NAVMED 6260/7 forms and the CD or DVD with their corresponding chest X-ray images are to be sent in the same package. Forms should be stacked in the order the corresponding image is listed on the CD or DVD. The NMCPHC Memorandum authorizing the B readings is to be included. Prepare a mailing label for the CD or DVD mailer case with the B reader's address. (Only for MTFs still using carbon copy forms: Prepare a second mailing label with the MTF address to which the B reader should return the completed NAVMED 6260/7 forms. Place the second label in the mailing case with the CD, NAVMED 6260/7 forms, and the memo.) Mark the envelope Confidential.

A certified tracking method (certified mail by USPS, FEDEX, or UPS) is used, and this information is mailed to NMCPHC or emailed to usn.hampton-roads.navmcpubhlthcenpors.list.nmcphc-amsp@mail.mil.

The B reader will return the completed form along with the CD and invoice for payment to NMCPHC for processing into the Data Registry. NMCPHC will fax (or encrypted email) the completed NAVMED 6260/7 back to the ordering MTF. This is incorporated into the worker's occupational health record. If the NAVMED 6260/7 form is returned to the MTF by the B reader with the determination that the radiograph was unreadable, the MTF is responsible for taking appropriate action to obtain a readable chest radiograph.

When the completed NAVMED 6260/7 is received back from the B reader, the MTF compares the number of forms received to the number sent. (If forms are missing, a new copy of NAVMED 6260/7 is generated for each missing form and NMCPHC is contacted.) The provider at the MTF reviews the B reading and takes any action appropriate, and the NAVMED 6260/7 is placed in the worker's employee health record.

If the completed NAVMED 6260/7 forms are not returned to the clinic within two (2) months from the date the images were mailed, then NMCPHC is to be contacted at 757-953-0779.