Sample Wellness Medical Physical Exam (FCSN) HANDS-ON PHYSICAL EXAMINATION 1 Vital Signs: Head, neck, eyes, ears, nose and throat 1 Cardiovascular: Inspection, auscultation, percussion and palpation 1 Pulmonary: Inspection, auscultation, percussion and palpation 1 Gastrointestinal: Inspection, auscultation, percussion and palpation 1 Genitourinary: Hernia exam (see cancer screening) 1 Lymph Nodes: The examination of organ systems must be supplemented with an evaluation of lymph nodes in the cervical, auxiliary and inguinal regions. 1 Neurological: The neurologic exam for uniformed personnel must include a general mental status evaluation and general assessment of the major cranial/peripheral nerves (motor, sensory, reflexes). 1 Musculoskeletal: Includes an overall assessment of range of motion (ROM) of all joints. Additionally, observation of the personnel performing certain standard office exercises or functions is helpful in assessing joint mobility and function. BLOOD ANALYSIS The following are components of the blood analysis. At a minimum, laboratory services must provide these components in their automated chemistry panel (SMAC 20) and complete blood count (CBC) protocols: 1 White Blood Cell Count, Differential, Red Blood Cell Count (Hematocrit) and Platelet Count 1 Liver Function Tests, which includes SGOT/AST, SGPT/ALT, LDH, Alkaline Phosphatase and Bilirubin 1 C-Reactive Protein and Triglycerides 1 Cholesterol, which includes Total Cholesterol, Low Density Lipoprotein (LDL-C) level, High Density Lipoprotein (HDL-C) level and Total Cholesterol/ HDL Ratio 1 Glucose, if over 120 then HbA1c 1 Blood Urea Nitrogen, Creatinine, Sodium, Potassium, Carbon Dioxide, Total Protein, Albumin and Calcium URINALYSIS 1 Dip Stick: Includes pH, Glucose, Ketones, Protein, Blood and Bilirubin 1 Microscopic: Includes WBC, RBC, WBC Casts, RBC Casts and Crystals VISION TESTS Assessment of vision must include evaluation of distance, near, peripheral and color vision. Evaluate for common visual disorders. PULMONARY (SPIROGRAM) 1 Every year for smokers 1 Every three years for nonsmoker CHEST X-RAY 1 Every five years STRESS EKG* WITH VO2 VALUE CALCULATED 1 Members 30-years-old and under will be tested on treadmill every third year. 1 Those 30 to 39-years-old will be tested on treadmill every other year. 1 Those 40 and older will be tested yearly. *Abnormal Cardiac Follow-up — Electron Beam Tomography (EBT) ONCOLOGY SCREENING ELEMENTS 1 Prostate Specific Antigen (PSA), fecal occult blood testing and skin exam 1 Additional screenings based on need or at the request of the patient may also be provided during the base-line exam. CANCER SCREENING 1 Digital rectal exam 1 Testicular exam 1 Clinical breast examination 1 Pap smear IMMUNIZATIONS AND INFECTIOUS DISEASE SCREENING 1 Tuberculosis Screen (Annual PPD) 1 Hepatitis C Virus Screen 1 Hepatitis B Virus Vaccine 1 Tetanus/Diphtheria Vaccine (Booster) 1 Measles, Mumps, Rubella Vaccine (MMR) 1 Measles Vaccine, Mumps Vaccine 1 Rubella Vaccine, Polio Vaccine, Hepatitis A Vaccine 1 Varicella Vaccine, Influenza Vaccine 1 HIV Screening (required to be offered) HEAVY METAL AND SPECIAL EXPOSURE SCREENING (AS NEEDED) Arsenic (urine), Mercury (urine), Lead (urine), Lead (blood), Aluminum, Antimony, Bismuth, Cadmium, Chromium, Copper, Nickel, Zinc - Organophosphates (RBC cholinesterase), Polychlorinated Biphenyls (blood) (i)A work history and medical history with special attention to skin, respiratory and gastrointestinal systems, and those nonspecific symptoms, such as headache, nausea, vomiting, dizziness, weakness or other central nervous system dysfunctions that may be associated with acute or chronic exposure to AN. (ii) A physical examination giving particular attention to central nervous system, gastrointestinal system, respiratory system, skin and thyroid. (iii) A 14" x 17" posteroanterior chest x-ray. (iv) Further tests of the intestinal tract, including fecal occult blood screening and proctosigmoidoscopy, for all workers 40 years of age or older, and for any other affected employees for whom, in the opinion of the physician, such testing is appropriate. APPENDIX C 3 2