Medical Matrix Manual Change Log

May 4, 2022

Asbestos and Silica programs (113, 114, 187)

  • The SF600 will more accurately convey when B readings are required. This was a software update only; no changes were made to these programs in the Matrix Manual.

Beryllium (121)

  • The software was updated so that the text field to enter BeLPT is large enough to write in. This was a software update only; no changes were made to this program in the Matrix Manual.

Blood and Body Fluids program (178)

  • Provider Comments were modified to address 2-dose hepatitis B vaccinations.

Child Care Worker (703)

  • References were modified to add Air Force and DoD instructions and to update hyperlinks.

Various programs

  • MMO will not print a page for physical exam findings including the fields for vital signs if a program has no physical exam requirements. This change was made in the previous release but it was not documented.


October 6, 2021

Asbestos Past Worker programs (115 and 116)

  • These programs were combined into a single program, Asbestos Past Worker (114), as requirements for 115 and 116 have been modified so as to be the same.

Blood and Body Fluids program (178)

  • The opinion letter text now specifies that it can be considered a screening rather than an examination. Some required text was added at the bottom of the letter.

Child Care Worker program (703)

  • Modified to clarify that hepatitis A vaccination is only necessary depending on local risk (see Provider Comments), hepatitis A titer was removed, and another reference (17) was added.

Chromic Acid/Chromium (VI) (133)

  • Removed spirometry as a line item as it is not required by OSHA or DoD and is considered unnecessary.

Explosives Handler and Explosives Material Handling Equipment Operator (721)

  • Modified to clarify text in the Provider Comments about which Category forklift operators fall into depending on whether they handle explosive (Category D) or not (Category E).

Firefighter (707)

  • Added text to the Provider Comments clarifying that the NFPA 1582 is not the DoD FF medical standard.

Police/Security Worker (714)

  • Corrected references (1) and (3).

Blood and/or Body Fluids (178), Childcare Worker (703), Police (714)

  • Programs were modified to clarify that hepatitis dose #3 is not required if the worker has received Heplisav-B and that positive anti-HBs titer is sufficient evidence of immunity (in accordance with an OSHA letter, added as a reference).

Blood and/or Body Fluids (178), Childcare Worker (703), Health Care Workers (719), Respirator User Certification (716), Wastewater/Sewage Worker (702)

  • These programs are now considered screenings or "Screening Certifications" to make it clear that nurses are able to sign the forms

January 20, 2021

Asbestos Past Worker - 0 To 10 Years (116)

  • Modified so the B reading line item no longer refers to Provider Comments.

Asbestos Past Worker programs (116) and (115)

  • The periodicity was changed to be consistent at 5 years, and chest X-rays for B reading are not done if the previous AMSP B reading (as part of the PW program or within 12 months as part of the Current Worker program) was negative or if the worker's previous B reading identified asbestos-related abnormalities and the worker is being followed as Worker's Comp.

Arsenic Program (112)

  • Modified so only a Baseline chest X-ray is required, in accordance with Reference (1).

Beryllium (121)

  • Modified to include BeLPT labs and DoD CBD Diagnostic Centers.

Heat Program (502)

  • Reference (1) was updated to the current NIOSH recommended standard.

Latex Program (310)

  • Removed Program Description text referring to the Health Care Worker Program.

Police Security Workers (714)

  • The Program Description was modified to clarify that active-duty military are required to participate.

November 4, 2020

Firefighter (707)

  • Several exam elements were corrected to reflect the 10/14/2020 change log entry.
  • Provider Comments were revised to clarify use of Reference (2). Reference (2) was updated to the 2018 edition of the NFPA 1582

October 22, 2020

The Medical Matrix Manual released on 10/21/2020 was missing the Chemical Stressors chapter; this has been corrected.

October 21, 2020

The link to download the Medical Matrix Manual was fixed to point to the current (10/14/2020) revision. Check that the revision date on the title page is 10/14/2020 to ensure you have the correct version.

October 14th, 2020

Acrylamide (103)

  • Modified, changing OPNAV 5100/15 to Data Grid 5100/15, as the OPNAV 5100/15 is no longer current. Periodicity of the major illness and hospitalization line items was changed from Yes to No. Line items about back injury, drinking, heart disease, high blood pressure, and medication allergies were removed as they were considered unnecessary.

Allyl Chloride (105)

  • Modified, changing OPNAV 5100/15 to Data Grid 5100/15, as the OPNAV 5100/15 is no longer current. Periodicity of the major illness and hospitalization line items was changed from Yes to No. Current medication use line item Baseline and Periodic was changed to Yes. Line items about back injury, heart disease, medication allergies, and reproductive health concerns were removed as not being necessary.

Anesthetic Gases (108)

  • Removed the exam line item "testes," as no basis for its inclusion was found.

Animal Associated Disease (207)

  • Modified to enable the option for a Periodic SF600.

Arsenic (112)

  • Periodicity was changed to "Variable" and a statement was added to the Program Description clarifying arsenic surveillance periodicity (every 6 months unless the worker is 45 or younger AND has worked with arsenic for 10 years or less) so that it more accurately reflects OSHA regulations.

Beryllium (121)

  • Modified, inserting text in the Program Description clarifying compliance dates for General Industry and for Construction and Shipyard.

Cadmium, current exposure (124)

  • Clarified that CXRs are required at baseline and termination. (As providers may always order additional tests in occupational medical surveillance, the current wording was felt unnecessary and confusing.)

Child Care Worker (703)

  • Updated to clarify that influenza immunization is not required if the worker has an exemption. Modified to eliminate confusion about requiring hepatitis A titers. “Hepatitis A titer” was changed to “Hepatitis A titer unless 2 doses vaccine documented.”

Chromium (133)

  • The physician's opinion letter was modified, removing paragraph 1.d. as it was unnecessary. The Matrix Manual was corrected to include the physician's written opinion line item.

Explosives Handler and Explosives Material Handling Equipment Operator (721)

  • Modified, replacing "sleep disorder, breathing pauses while sleeping, sleep apnea, loud snoring, insomnia, daytime sleepiness" with "narcolepsy," as some providers were ordering sleep studies out of concern for OSA, which is generally not a concern for program 721. Current medication use line item Baseline and Peri changed to Yes, and Term changed to No. Removed line items Urine RBCs and Urine WBCs. There is already "urine blood" listed as a line item, and urine WBCs is unnecessary to determine medical qualification. This will also help clarify that urine microscopic is not required.
  • "Peripheral vascular system, including acral (distal) microcirculation and evidence of Reynaud’s" corrected to be not required for a Termination exam.

Firefighter (707)

  • Change PERI to 40+ to correlate with NFPA. The Vision Acuity standard was clarified to 20/30 or 20/70 corrected to correlate with OPM.
  • Color vision: testing requirement was dropped and a history questionnaire question was added (secondary to the many available tests causing difficulty with interpretation).
  • Peripheral vision: TERM requirement removed (unsure of value of additional information).
  • Hepatitis A and B immunizations and titers line items were modified for clarity.
  • MMR and Varicella vaccinations were removed, as they are not specifically required of Firefighters.
  • Td (Tdap once) changed to "Td every 10 years or Tdap once" for clarity.
  • Removed "letter" and leave statement to read "physician's or provider's written opinion" for clarity.
  • The following line items were removed because they were considered unnecessary, or redundant, or otherwise already implied: Major illness, Hospitalization, Medication allergies, Seat belt use, Reproductive health concerns, Acclimating to heat, Chest surgery, Exposure (acclimatization) to heat, Contact lens use, Color blindness, Eye irritation or blurred vision, Any other eye or vision problem, Frequent pain or tightness in your chest, Infertility or miscarriage, Thyroid disease, Sleep disorder, Personality or behavior change, Exposure to noise, Skin irritants, Respiratory irritants, Carcinogens, Overall physical fitness, Metabolic disturbance, Evidence of recent or current substance abuse, Other appropriate examination, Immunizations current, Tuberculosis screening questionnaire (implied in "by risk" PERI evaluation), Surveillance/PPE consistent with exposures, Abnormalities possibly related to exposures/occupations
  • OPNAV 5100/15 was changed to Data Grid 5100/15, as the OPNAV 5100/15 is no longer current.
  • Fasting blood glucose was changed to baseline only.
  • CXR was changed to Base and Term
  • EKG was changed to annual starting at age 40
  • Provider Comments were added that diabetics should demonstrate effective disease management.
  • Modified to eliminate confusion about requiring hepatitis A titers. “Hepatitis A titer” was changed to “Hepatitis A titer unless 2 doses vaccine documented.”

Forklift Operator (710)

  • Provider Comments were modified to clarify distant visual acuity.

Health Care Worker (719)

  • Modified to conform to 2019 CDC guidelines by: Removing the line item “Tuberculosis screening questionnaire” and changing TB testing to Baseline only. Questions about reproductive concerns, allergy, and having been evaluated for latex allergy were removed also; by rewording line items about MMR and Varicella immunizations and titers to clarify that immunizations and titers are only done when necessary; by removing exam elements (pregnancy, infertility, adverse reaction to vegetables or fruit, latex allergy, multiple operations, anaphylaxis, itchy eyes when using latex gloves, and TB questionnaire) and adding meningococcal vaccine for those routine exposed, and adding explanatory text to the Program Description and Provider Comments.

Heat Program (502)

  • Replaced the line item "Obesity" with "BMI," as the latter was felt to be more meaningful.

NCIS (713)

  • Modified, clarifying that SECNAV 5100/1 is to be used and the PWO is no longer needed." The NCIS address, Naval Criminal Investigative Service Code 10D Physical Exams, 27130 Telegraph Rd, Quantico, VA 22134-2253 and email: were removed from the text, as they were unnecessary.

Police/Security Worker (714)

  • Program Description was modified to clarify visual acuity requirements.

Respirator User Certification Exam (716)

  • Modified by removing the word "exam" from the title, and text was added to the Provider Comments clarifying that a physical exam is only required if "Yes" answers are obtained. This was to clarify the role of non-providers.

Silica (187)

  • Modified, changing OPNAV 5100/15 to Data Grid 5100/15, as the OPNAV 5100/15 is no longer current. Line items about medication changes, back injury, alcohol, medication allergies, reproductive health concerns, tuberculosis or PPD Converter, positive TB test, and eyes were deleted as unnecessary.

Wastewater/Sewage Worker (702)

  • Modified, changing OPNAV 5100/15 to Data Grid 5100/15, as the OPNAV 5100/15 is no longer current. Current medication use line item Baseline and Peri changed to Yes, and Term changed to No. Line items about health status, medication changes, major illness, hospitalization, cancer, back injury, drinking, smoking, heart disease, medication allergies, and reproductive health concerns were deleted as unnecessary. Program Description text about OCONUS vaccinations for hepatitis A, typhoid, and polio was deleted and added as a line item.

Weight Handling Equipment (704)

  • Modified, changing OPNAV 5100/15 to Data Grid 5100/15, as the OPNAV 5100/15 is no longer current. Periodicity of illness, hospitalization, and back injury items was changed from Yes to No. Many line items were removed. Exam of eyes was clarified to indicate extra-ocular movement; color vision was clarified to indicate red-green-yellow. Neurological exam was added (to replace Central nervous system and Peripheral nervous system).

Welders/Braziers, etc. (708)

  • Modified, changing OPNAV 5100/15 to Data Grid 5100/15, as the OPNAV 5100/15 is no longer current. Periodicity of the major illness and hospitalization line items was changed from Yes to No. Current medication use line item Baseline changed to Yes, Peri and Term changed to No. Line items about cancer, back injury, drinking, smoking, heart disease, medication allergies, reproductive health concerns, and Chest X-ray were removed as not being necessary. Visual acuity was clarified to "near or intermediate visual acuity."
  • Provider Comments were modified to clarify near or intermediate visual acuity, and that a functional exam by the supervisor should be done for those who do not perform satisfactorily on the color vision screening exam.


  • Introductory paragraph C1.5 Chemical Stressors List was removed, as that list is no longer available for download. Mention of and references to the Chemical Stressors List were removed from the Introductory chapters, and Chapter 10 was removed entirely. Mention of the List was also removed from all programs and from the references in programs 150, 155, 156, and 196.
  • Introductory text on page 9 was modified to identify June 2019 as the most recent OPNAV 8020/6. Explosives Handler and Explosives Material Handling Equipment Operator 721 Provider Comments were modified to remove the date of the OPNAV 8020/6.

June 12th, 2019


  • Removed several standard questions (smoking, heart disease, medications, allergies) considered to be unnecessary.
  • The line item "Exposure to potentially infectious body fluids" was changed to "Prior exposure to potentially infectious body fluids."
  • Removed the latex allergy question line item.
  • Provider Comments added HBsAg testing on those who have not developed an antibody response to hepatitis B immunization, and to direct chronic carriers to their PCP for follow-up.

CADMIUM (Current Exposure) (124)

  • Replaced all * Baseline items with YES.
  • The * was removed from its paragraph in the Provider Comments.
  • The ** Periodic items were replaced with *, and the ** was removed from its paragraph in the Provider Comments and replaced with * (a single asterisk).
  • A bug was fixed where Chest X-ray was not showing up on the SF-600
  • The Chest X-ray line item was reworded from "Chest X-ray (PA) initially, then only if ordered by physician" to "Chest X-ray (PA) at Baseline, then only if ordered by physician," and the Periodic column entry * was replaced by YES. This was to clarify that a Periodic CXR was to be considered by the physician but only to be done if deemed necessary.


  • Line items "Has anything about your health status changed since your last examination" and "Have any medications changed since your last exam" were removed.
  • In the disposition, return for follow-up exams section of the SF-600, it will no longer automatically fill in "in one year" for this program.
  • Reference 4, 6, and 10 links were updated.
  • A link was added to reference 11.
  • Reference 5 was deleted.


  • References 4 and 5 links were updated.


  • Added TB testing at Baseline.
  • Silica was added to paragraph heading C6.4 in the Matrix manual.

May 20th, 2019

Benzene (117)

  • Provider Comments were re-worded and re-formatted so that the information in the paragraph that started with "Guidance on emergency examinations" could be more readily noticed and more quickly read.

Cadmium Current Exposure (124)

  • Modified to meet current OSHA requirements: line items RBC, WBC, HGB, and Platelets were added. Line items AST, ALT, Bilirubin, Total, Alkaline phosphatase were removed, as they had been included because of a 1978 NIOSH recommendation and are not required by OSHA. Urine nitrite was removed because it had only been added as something usually included in routine urinalysis but is not pertinent to cadmium exposure.


  • Updated MSCA-5875/6 to most recent revision (Expiration 11/30/2021)

Firefighter (707)

  • Provider Comments text was modified to clarify Hepatitis A vaccine OR (not AND) titer.

Inorganic lead (161)

  • Corrected so line item RBC Morphology (Peripheral Smear), which was listed in the PDF version, also appears in the SF600 form for Baseline and Termination exams.

NCIS (713)

  • Added "Complete SECNAV 5100/1" disposition element
  • Fixed SECNAV form missing for MD letter download


  • Urine nitrite was removed as a line item from all programs as no OSHA program requires that test.

November 21st, 2018

Animal Associated Disease (207)

  • Added a line item, "Animal-specific titers as indicated (see Provider Comments)," to alert users that handlers of certain animals may require more than just a TB questionnaire.

Asbestos Current Worker (113)

  • Identification of DD2493-1 and -2 was corrected from “DoD” to “DD”.

Beryllium (121)

  • Modified to clarify that, as of July 2018, the OSHA General Industry standard will not be enforced by OSHA for the Shipyard and Construction industries.

Blood and/or Body Fluids (178)

  • Reclassified as a Specialty, Certification Examination, as the outcome of Qualified (or not) was considered more appropriate than "No abnormalities from occupational exposure," etc.
  • The written opinion letter was modified to clarify that recommendation for Hepatitis B immunization is irrespective of current immune status.

Explosives Vehicle Operators (720)

  • Modified to clarify that the OPNAV 8020/6 is used only for Military (Category B) drivers.
  • The expired MCSA-5876 form was replaced by the newest version, and references to the 2018 versions of MCSA-5875 and MCSA-5876 were updated."

Inorganic lead (161)

  • Added HCT and RBC Morphology (Peripheral Smear) exam elements to meet the OSHA requirement for "Examination of Peripheral Smear Morphology" using terminology that is more commonly used by laboratories.
  • Added exam elements for past exposure to lead, urine microscopic, and teeth exam. (The changelog dated 7/17/18 stated that these items had been added but they were accidentally left out of the update. This has now been corrected.)

Motor Vehicle Operators (DOT) (706)

  • Modified to clarify that the OPNAV 8020/6 is used only for Military (Category B) drivers.
  • The expired MCSA-5876 form was replaced by the newest version, and references to the 2018 versions of MCSA-5875 and MCSA-5876 were updated."

Noise (503)

  • The Program Description was modified to clarify that workers exposed to noise only need to be seen by the OH clinic at locations where audiology is located in the OH clinic.

OCONUS (798)

  • Added a line item informing worker DD2900 required upon return.
  • Added tetanus immunization as a requirement
  • Clarified that malaria prophylaxis, if prescribed, is provided free of charge.

Police/Security Worker (714)

  • Modified to reflect the 2018 update to reference 1 and to include the specific OPM reference and text regarding medical requirements.

Respirator User Certification Exam (716)

  • Corrected the link in reference 8.

Silica (187)

  • Corrected reference (1) link to the NMCPHC AMSP page.


  • Chapter 2 was modified to reflect that a traditional doctor-patient relationship does not exist when performing occupational medical surveillance.

July 18th, 2018

Asbestos Current Worker (113)

  • The OSHA Shipyard program for asbestos was added as a reference.

Beryllium (121)

  • The statement that Shipyards and Construction do not have to meet all OSHA General Industry Be requirements was removed, as OSHA now requires all three to follow the general industry best standard.

Explosive Handler (721)

  • Provider Comments were modified to clarify that Explosives Handlers are now Category D on the 8020/6 (REV. APR-2018), and explaining that obstructive sleep apnea, unless causing severe drowsiness, is not a concern for 721, and that workers with severe drowsiness or narcolepsy should be disqualified.

Firefighters program (707)

  • Baseline HIV testing was removed. This is in anticipation of an updated DoD 6055.05-M and as HIV testing for occupational medical purposes is not justified.

Forklift Operator / Material Handling Equipment (710)

  • Provider Comments were modified to include a reference to the discussion of sleep apnea in Program 721.

Health Care Workers (719)

  • A typographical error in the Provider Comments was corrected.

Inorganic Lead (161)

  • The Program Description and Provider Comments were revised to reflect the changes to the lead program in DoD 6055.05-M Change 2, April 17, 2017. The major change is lower levels for removal from and return to lead work. Also, line items for past exposure to lead, urine microscopic, and teeth exam were added.

Motor Vehicle Operators (DOT) (706) and Explosives Vehicle Operators (720)

  • Modified to clarify that only Military drivers require OPNAV 8020/6, and that the elements of those programs are in 49 CFR 391.41-49.

OCONUS (798)

  • Program was significantly revised, eliminating all previous exam elements and now pointing to specific requirements of the COCOM.


  • Intro chapter C.6.1. was updated to include mention of OPNAV 8020/6 (REV. APR-2018). A second paragraph emphasizing that additional tests are not to be ordered as added.

May 2nd, 2018

Asbestos Current Worker Program (113)

  • To clarify that providers are to examine the cardiovascular, respiratory, and digestive systems as required by OSHA, 5 line items were added: cardiovascular system, respiratory system, abdomen, liver, and extremity exam.

All Asbestos programs (113, 115, 116)

  • Added disposition exam element "Complete NAVMED 6260/5"

Beryllium (121)

  • Written opinion letters were revised to clarify that Providers could write the letters. Also, "circled" was corrected to "marked."

Cadmium Past Worker (208)

  • Program disposition was modified to include a check box for no further Cd program participation necessary.

Chromic acid/Chromium (133)

  • Modified so blood and urine testing is no longer routinely done, and chest X-rays are only done at baseline. This was done to be consistent with OSHA requirements and 2005 NIOSH guidance (superseding the 1978 NIOSH guidance). A Provider Comment was added that providers may order further tests if warranted by abnormal findings.

Crystalline Silica Program (187)

  • Revised extensively to comply with the new OSHA Silica standard. Notable changes include 3 year periodicity of history, physical exam, and tests, including B-reading, and 2 provider's letters (1 each to the employer and to the employee) are required. Added physician sample letters to the worker and to the employer.

Explosives Vehicle Operators (720) and Motor Vehicle Operators (DOT) (706)

  • The last page of the SF600 was modified to include information related to OPNAV 8020/6, and space for the date of PCM follow-up was removed to reduce confusion as to whether the OH provider should make the appointment.

Hand Arm Vibration (508)

  • Physical exam element "eyes" was removed as a required element.

Health Care Workers (719)

  • TB screening by questionnaire was changed to only be required if the risk assessment of the MTF has found the MTF to be other than low risk for TB. To avoid workers coming for annual surveillance when all they need is influenza immunization, Periodicity was changed from Annual to Baseline only (except high TB risk)*. The Program Description was modified to explain that.

Wastewater/Sewage Worker (702)

  • Revised so that polio immunization is no longer required and may be considered if indicated by local OCONUS conditions.


  • Added a field for rate of FEV1 decline to the spirometry section.
  • All follow-up periods in the disposition section are now included in editable text fields in case the provider needs to specify a different period.
  • Removed the word "Every" from program periodicities. E.g. "Every 2 years" becomes "2 years".
  • The line items (found in many programs) were modified to reduce confusion in the SF600. "Required" was removed from the Physician's or provider's written opinion letter. "Is surveillance/PPE consistent with exposures" was reworded to "Surveillance/PPE consistent with exposures." "Are any abnormalities related to exposures/occupations" was reworded to "Abnormalities possibly related to exposures/occupations."

Oct 11th, 2017

Silica & Asbestos exams (113, 115, 116, 187)

  • Corrected periodicity for B-read X-ray for Silica exams and combined Silica/Asbestos exams as output by MMO (no change to the Matrix Manual).

Asbestos Past Worker 10+ (115) & Asbestos Past Worker 0-10 (116)

  • Removed the requirement to notify NMCPHC of incorrect worker placement in the AMSP.

Beryllium 121

  • Revised to conform to the new OSHA beryllium standard, including exam periodicity and BeLPT test every 2 years and physician opinion letters both to the supervisor and to the worker.

Cadmium programs 124 & 206

  • Modified to include a line item to ensure dilute urine is not sent for analysis, and Provider Comments were added explaining the item and referencing a corresponding OSHA interpretation.

Cadmium Current Exposure 124

  • Minimum urine pH and specific gravity requirements were added to the provider comments.

Herbicides 216

  • Corrected so Chest X-ray (PA) is baseline as well as periodic (as in Matrix versions 10 and 11).

Firefighter 707

  • Examining for testicular mass was removed as it is not required and is considered preventive medicine.

Noise 503

  • Boxes for vital signs were removed from the SF 600, as vital signs are not required when only an audiogram is performed.

Radiation, Ionizing 505

  • You can no longer select this program from within MMO because examinations for this program are to be completed using NAVMED form 6470/13, Medical Record - Ionizing Radiation Medical. See the Matrix Manual for this program for more information.


  • Chapter 5 - Placement of Workers in Medical Surveillance Programs - was modified to clarify reasons and responsibilities for enrolling workers in medical surveillance programs.

June 21th, 2017

Arsenic 112

  • Mention of B-reading and ILO rating of the chest X-ray was removed from the Provider Comments, as these are not required. (B-reading was not listed in the PDF table or the SF600.)

Formaldehyde Program 151

  • A statement was added to Formaldehyde Program 151 Provider Comments indicating that biomonitoring for formaldehyde is not feasible.

Latex 310

  • Question items about anaphylaxis were modified slightly to be uniform with Health Care Workers 719

Radiation, Ionizing 505

  • Program Description changed slightly to clarify who may perform the exam.

Wastewater/Sewage Worker 702

  • Added text to the program description directing OCONUS activities to develop, in consultation with local health authorities, Hep A and other vaccination recommendations.

NCIS 713

  • Corrected the program number:  "Agent must also be cleared for Motor Vehicle Operator (Other than DOT)  Matrix Program 714" to "… Matrix Program 712".
  • Updated NCIS contact email address

Police/Security Worker 714

  • Remove LFTs, BUN and creatinine

Health Care Workers 719

  • Hepatitis immunizations were removed as not all Health Care Workers are potentially exposed to hepatitis B, and a separate program exists for those exposed to blood and body fluids.
  • Description of what establishes MMR immunity was changed to be consistent with BUMEDINST 6230.15, Immunizations and Chemoprophylaxis
  • Question items about anaphylaxis were modified slightly to be uniform with Latex 310

Explosive Handlers 721

  • Fixed link to NAVMED P-117 reference


  • All age dependent programs - changed age range descriptions to be consistent; all ranges are inclusive - e.g. "Up to 34, 35 to 44, 45+"
  • Updated the "Last Revision" dates for several programs that have been updated more recently than the previously stated last revision date.

November 16th, 2016

207 Animal Associated Disease

  • Added history element regarding asplenia.
  • A brief discussion of Capnocytophaga risk to immunocompromised, especially asplenic, individuals was added to the Provider Comments.
  • A reference to the Army Standards of Medical Fitness was added.

706 Motor Vehicle Operators (DOT) & 720 Explosives Vehicle Operators

  • All exam elements were removed and replaced with requirements to use the Department of Transportation Federal Motor Carrier Safety Administration forms in addition to the OPNAV 8020/6.
  • A download link to the MCSA-5875 form will appear under “MD Letters” in MMO when 706 or 720 are selected programs.

719 Healthcare Workers

  • Termination was corrected to be "No" for all exam elements.


  • Periodicities listed as "biennial" were changed to read "every 2 years" in order to reduce confusion.
  • Guidance for providers encountering individuals who are found not to be medically qualified was added as section C7.4
  • In some cases MMO provides links to forms under the “MD Letters” section that aren’t actually opinion letters (e.g. for 506 Radiation – Laser, a downloadable Amsler grid is provided). As side-effect, “Physician’s or provider’s written opinion required” would incorrectly print on the SF-600. This side-effect has now been fixed.

April 7th, 2016

110 Hazardous Drugs

  • Clarification added that surveillance for Hazardous Drug handlers is to be uniform. Explanation added that PT is for anticoagulant effects of antineoplastics and thyroid studies are for nivolumab.  Thyroid studies added line items and explanatory text to the Provider Comments.

113, 115, 116 Asbestos Programs

  • Include requirement for use of digital radiographs for B-reading, references to NIOSH and DHHS final ruling, and reference to the OEM FOM for asbestos record storage requirements.

113, 115, 116 Asbestos Programs & 187 Silica

  • Change exam element “Chest X-ray (B-reader) - using NAVMED 6260/7” to “Chest X-ray (B-reader) - using NAVMED 6260/7 (only if required per Provider Comments)” in the manual and list the periodicity of the B-reading X-ray, which is based on time since first exposure and worker's age, on the SF-600.
  • The B-reader X-ray will show up as a separate item from other X-rays specified in other programs due to potential differences in periodicities.  In some cases a worker may need a chest X-ray annually but only need a B-reading every five years, for example.

215 Methyl bromide

  • Chest X-ray and annual spirometry were removed (baseline spirometry remains), and references 2-4 were deleted.

506 - Radiation (Laser)

  • Added reference 6.
  • Link to Amsler Grid PDF added. 
  • In MMO, download link for Amsler Grid will appear under MD Letters when 506 is selected.

703  Childcare Worker

  • Add Polio, TD/Tdap, Hepatis B (1,2,3 & titer)
  • Add Tuberculosis skin/blood test

707 Firefighter

  • Replace “Seasonal Influenza Vaccination” with “Seasonal Influenza Vaccination (offer to worker)”.
  • Some notable changes were made to the provider comments including added text clarifying the consideration of risk factors in determining firefighter medical certification.
  • Remove exam elements for Varicella, MMR and polio vaccinations.
  • There is now a “firefighter” MD letter available to download when creating an exam with the firefighter program.  It is simply a PDF containing the MD letters for the Blood and Body Fluids, Hazardous Waste Workers, and Noise programs.

710 Forklift OperatorMaterial Handling Equipment

  • Clarification regarding monocular and binocular vision requirements. Discussion and an OSHA reference added emphasizing depth perception importance. Lateral gaze standard noted. Colorblindness mentioned.
  • Reaction time requirement mentioned but identified as being obsolete. Hearing acuity requirement clarified to use modern, rather than obsolete, terminology.
  • Discussion added about amputees as potential operators. Comment added that MHE operators should be at least healthy enough to safely drive on public roads.
  • Text was added clarifying the lack of minimum standard for (and the importance of) depth perception, and stating who may perform the 710 exam.

714 Police/Security Worker

  • Baseline spirometry added in conformity to Army Regulation AR 190-56.

719 Healthcare Worker

  • “H. Annual influenza immunization for HCWs is required.” Replace “required” with “mandatory”.
  • Removed a statement implying clinics are responsible for contracts to comply with state laws and for contract workers are up to date with screening and testing. 
  • Added NAVMED 6224/8 (Rev. 3-2011), Tuberculosis Exposure Risk Assessment as reference 11.
  • Modified the TB exposure assessment text to clarify that it is by risk and that NAVMED 6224/8 is to be used (consistent with Child Care Workers).
  • Add Tuberculosis screening questionnaire
  • Add Tuberculosis skin/blood test


  • In all MD letters, SSN was replaced with “ID #”
  • Expiration for PDF exam forms increased from 90 to 180 days