East Valley Wellness Center, LLC will maintain the privacy and confidentiality of any protected health information examined or obtained during the course of performance of this agreement and execute a Business Associate Agreement as required under the Health Insurance Portability and Accountability Act of 1996. (HIPAA).
Components of the Annual Occupational Medical Evaluation will include:
1. Medical History - Annual questionnaire which includes changes in health status and known exposures since previous evaluation.
2. Respirator Medical Evaluation Questionnaire a. OHSA Standard CFR 29.1910.134 Respirator Protect Program b. Questionnaire supplied by individual station c. Physician, or Advanced Practice Provider, to be familiar with the above OSHA Standard and to supply a Respirator Certification document to appropriate station indicating the member's respirator status if required by District.
3. Physical Exam a. Vital Signs b. Head, Eyes, Ears, Nose and Throat (HEENT) c. Neck d. Cardiovascular e. Pulmonary f. Breast g. Gastrointestinal i. Rectal exam for mass ii. Occult blood h. Genitourinary i. Pap Smear ii. Testicular exam iii. Rectal exam for prostrate i. Hernia j. Lymph nodes k. Neurological l. Musculoskeletal m. Skin (includes screening for cancer) n. Vision
4. Blood Test a. Complete Blood Count (CBC) with differential, Red Blood Cells (RBC) indices and morphology and platelet count b. Electrolytes (Na, K, C1, HC03, or C02) c. Renal function (Blood Urea Nitrogen (BUN), creatine) d. Glucose e. Liver function test (Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), direct and indirect bilirubin, alkaline phosphatase) f. Total cholesterol, High-density lipoprotein (HDL), Low-density lipoprotein (LDL), clinically useful lipid ratios, and triglycerides g. Prostate specific antigen (PSA) after age forty (40) for positive family history, if African American, or otherwise clinically indicated; after age fifty (50) for all other male members
5. Urine Laboratory Test a. Dipstick analysis for glucose, ketones, leukocyte esterase, protein, blood, and bilirubin b. Microscopic analysis for Red Blood Cells (RBC), White Blood Cells (WBC), casts, and crystals if indicated by results of dipstick c. Analysis for occupational chemical exposure
6. Audiology - Results will be compared with baseline and subsequent test results. Standard threshold shifts shall be corrected for age as permitted by OSHA. Hearing thresholds will be assessed in each ear at the following frequencies: a. 500 Hz b. 1000 Hz c. 2000 Hz d. 3000 Hz e. 4000 Hz f. 6000 Hz g. 8000 Hz
7. Spirometry - Results will be compared with baseline and subsequent test results and will be corrected to American Thoracic Society guidelines and normative equations found in Knudson et al. (1983) and American College of Occupational and Environmental Medicine (2000). a. Forced Vital Capacity (FVC) b. Forced Expiratory Volume in one (1) second (FEV1) c. FEV1/FVC Ratio
8. Chest Radiographs - Results will be compared with baseline and subsequent test results. Chest x-rays will be done every five (5) years or when medically indicated.
9. Electrocardiograms a. Resting 12-lead ECG
10. Colon Cancer Screening a. Fecal Occult blood test for every member over forty (40) years old or earlier if clinically indicated.
11. Weight and Body Composition a. Body weight and body mass index shall be measured and recorded b. Body composition evaluation by skinfold measurement
Summary of additional testing (this testing will be concurrent with the NFPA Standard 1582-Components of the Annual Occupational Medical Evaluation of Members):
1. Stress Echo-cardiogram Recommendations (those who meet one of the criteria below) a. As recommended by Physician b. Positive or questionable changes on 12 lead ECG c. New onset of chest pain, symptoms of coronary disease, or known coronary disease d. Over the age of 45 (men) and 55 (women) with one or more of the following risk factors: i. Total Cholesterol > 240mg/dl ii. Hypertension (systolic > 140 or diastolic > 90) iii. Diabetes iv. Smoker v. Family History of premature Coronary Artery Disease (CAD) vi. Framingham risk score > 10 e. Metabolic Syndrome (meets 3 or more of the risk factors below) i. Abdomen Obesity (waist circumference > 40 in men, > 35 in women ii. Triglycerides > 150mg/dl iii. HDL cholesterol < 40mg/dl for men, < 50mg/dl for women iv. Blood Pressure > 135/85mm/hg v. Fasting glucose >110mg/dl, non-fasting glucose > 180 or an HbA1c > 5.7
2. Additional Blood Tests may include: a. NMR Lipoprofile (LDL particle size measurement) b. HbA1c c. Insulin Levels d. Thyroid Testing (TSH)