Appendix A: Functional Requirements for the Volunteer Electronic Health System Priority ratings for Appendix A are as follows

: M = Mandatory Requirement H = Highly Desirable Requirements A. Functional Requirements

1. Provide an Electronic Health Record (EHR) The EHR Shall: Number A1. EHR Description Priority A1.1 Record all relevant health, dental and mental health information using a standardized format. M A1.2 Be available for use throughout the lifecycle of the Applicant, Voluntee r, and Returned Volunteer. M A1.3 Record, integrate and display all relevant health information from vario us paper processes and various electronic interfaces. M A1.4 Provide an electronic health information intake form that will provide i nformation for the Pre-Service module. M A1.5 Provide an electronic health information intake form to populate the EHR . M A1.6 Allow all authorized users to enter all health, dental, and counseling a nd mental health related information. M A1.7 Collect and store for later use dental radiological information. H A1.8 Have the ability to use Voice Recognition software in English that accom modates a wide range of international accents to aid updates to the electronic c hart. H A1.9 Organize data within the electronic chart into easily accessible compone nts. M A1.10 Organize data components that include, but is not limited to: · sections for patient summary data (problem list) · medications · allergies · progress notes · clinical exam or treatment notes · health history forms · immunizations · test results · outside records scanned into chart · specialty consult notes · correspondence · clinical flow sheets · consents H A1.11 Organize data across all pertinent medical units by ICD coding. M A1.12 Organize data across all pertinent medical units by CPT coding. M A1.13 Organize data across all pertinent dental procedure and diagonostic CDT coding. H A1.14 Organize data across HHS Electronic Transaction Standards 45 CFR Part 16 2. M A1.15 Meet current ICD 9 coding requirements. M A1.16 Meet future ICD coding requirements as they become available. M A1.17 Have the ability to identify items that require attention by users, incl uding notes that are incomplete/unsigned, overdue procedures, labs/procedure rep orts needing review/signature, etc. H A1.18 Have the ability to capture and maintain progress notes in a standard, i ndustry recognized format. The progess notes shall have unlimited space. M A1.19 Provide a provision for progress notes that allow revisions to the note

only by addenda. M A1.20 Allow for the generation of progress notes to reflect email messages or phone correspondence with patients. H A1.21 Allow access to previous progress notes while entering the current note. H A1.22 Provide the ability to create problem lists of clients, sorted by curren t and past medical/surgical history and current list of medications with drug an d food allergies. H A1.23 Have pre-loaded word processing ability to ensure standardization of ter minology. H A1.24 Allow quick entry of medical information into the clinical templates wit h a minimum of keystrokes, clicks or taps. H A1.25 Allow Peace Corps medical staff to interactively receive, review and req uest medical screening, healthcare delivery, or health status claim information and generate chart entries. H A1.25 Allow Peace Corps medical staff to interactively review and approve diag noses from diverse contractors and health care partners. H 2. Provide comprehensive preconfigured clinical care templates in a Clinica l Decision Support System (CDSS) for utilization in primary care settings. The CDSS shall: Number A2. CDSS Description Priority A2.1 Come supplied with a comprehensive array of pre-configured ambulatory ca re clinical templates that can be utilized and regularly updated. M A2.2 Support clinical care template that address all major anatomical systems and their diseases. M A2.3 Supply clinical care template that include tropical diseases. M A2.4 Allow authorized users the ability to store and modify Peace Corps clini cal guidelines. M A2.5 Have the ability to apply Peace Corps medical policy and procedures to a dministrative and clinical determinations. M A2.6 Have the ability to link to peer-reviewed knowledge databases. H A2.7 Have multiple system alerts. M A2.8 Have alerts that include, but are not limited to: · Allergies, both medication and food · Missing forms such as: applicant cost-sharing, patient privacy, medical,dental, eye exam, and other individualized specialist exam requests · Incomplete forms: Missing signatures, dates, health status information · Medical alerts, such as periodic health requirements, immunization renewal, sugg ested follow-up Pap smear or mammogram, due for follow-up visit, etc · Five-day alert prior to end of medical evacuation status · Volunteer Health Delivery System processing messages · Daily diary of open cases to be reviewed · Expiring authorizations · Site visit recommendation follow-up M A2.9 Have alerts configurable to Peace Corps specific systemwide alerts. H A2.10 Have the ability to guide medical staff to conduct telephone triage usin g Peace Corps medical guidelines. M 3. Provide a Pre-Service Medical Screening Module The Pre-Service Medical Screening Module shall: Number A3. Pre-Service Medical Screening Module Description Priority A3.1 Include an electronic interface to the EHR. M A3.2 Provide automated medical clearance confirmation as upfront and early in the process as possible. M A3.3 Include the ability to provide an output of medical clearance administra

tive disposition to the VLMS so that other Peace Corps staff may oversee the pla cement and on-boarding tasks. M A3.4 Include the ability to store and use detailed information about the spec ific capacity of each overseas post to support a pre-existing health issue of a current or potential Peace Corps Volunteer. M A3.5 Include a secure portal for applicants to exchange critical processing c ommunication regarding but not limited to: Peace Corps HIPAA privacy notice; aut horization for Peace Corps to use and review medical information; medical histor y; requested health status information; other medical requests that form the med ical clearance process. M A3.6 Include alerts of changes to the in-country health resources made by aut horized users. M A3.7 Utilize medical information as early in the process as possible to ident ify qualified applicants, or to determine if current medical status must be reso lved before application can proceed. H A3.8 Include business processes that support the automated system to ensure a n efficient, expedient medical clearance process for applicants. M A3.9 Using improved business processes to ensure efficient processing, includ e a branch-logic, decision-tree medical clearance system that: 1) collects medical information questions; 2) decides sequence and type of follow on questions based on the answers to previous medical questions; and 3) applies automatically Peace Corps Medical Screening Guidelines to assess applicant's medical information in order to determine qualification to serve or t o alert the Pre-Service Nurse for exceptional administrative decision actions. M A3.10 Include the ability to store and configure medical clearance guidelines. M A3.11 Include a database of medical resource information from each Peace Corps Post so that applicant medical needs can be matched with all Posts that have th e medical resources to support the applicant once they are in the field as a Pea ce Corps Volunteer. M A3.12 Include an administrative label that describes the medical clearance dis position. M A3.13 Integrate with and be accesible to all application material. M 4. Provide a Practice Management System (PMS) to provide standardized quali ty of care throughout the lifecycle of the Volunteer. The PMS shall: Number A4. Practice Management System (PMS) Description Priority A4.1 Record use of treatment protocols. M A4.2 Record compliance or non-compliance of treatment protocols. M A4.3 Store descriptions of medical resources in a format that makes the infor mation available for use throughout the system. H A4.4 Coordinate scheduling and office communications, other than triage. H A4.5 Have the abilty to store, use and update an inventory of Host Country me dical resources. M A4.6 Have an inventory of Host Country medical resources that includes: · diagnostic facilities including the type of diagnostics; · locations of multiple diagnostic facilities; · practitioner names and professional credentials; and · number of patients a resource can accommodate. H A4.7 Have a medical supply/consumables inventory for disposable items used wi thin the individual health units. M A4.8 Be able to maintain bulk inventory in a centralized location, currently in Washington, D.C., that can interface with other Peace Corps inventory systems through the ESB. H A4.9 Be able to inventory by item regardless of location. H

A4.10 Be able to securely track inventory by patient name or ICD code. H A4.11 Communicate between authorized users of the system through web portals. M A4.12 Allow secure communication between authorized users to discuss clinical issues. H A4.13 Allow authorized users to access and submit medical information and lab results. H A4.14 Capture and report qualitative and quantitative survey data and provide reporting tools for analyzing survey data. H A4.15 Allow authorized users to access and submit survey data. H A4.16 Have Quality Assurance capability requiring documented, protected peer r eview activities that can be isolated from the rest of the medical record. M A4.17 Have the ability to manage multiple paper documents. H A4.18 Be able to automatically generate correspondence from pre-selected crite ria. H A4.19 Share a unique identifier with the VLMS. M A4.20 Validate data to prevent duplicate records. M A4.21 Provide a customizable dashboard of key metrics with drill-down capabili ties. H A4.22 Have grammar and spell check tools. H A4.23 Have ability to designate active and inactive files for administrative p urposes. H A4.24 Have ability to archive records as required by Peace Corps policies. H A4.25 Have the ability to set the look, graphics, and branding in accordance w ith Peace Corps practices. H

Appendix B: Technical Requirements for the Volunteer Electronic Health System Priority ratings for Appendix B are as follows: M = Mandatory Requirement H = Highly Desirable Requirements 1. Reports Collect, track, share, and generate reports on data for all components of the VE HS. The VEHS shall: Number B1. Reports Description Priority B1.1 Produce standard reports for management, monitoring, and compliance from any or all VEHS data. M B1.2 Produce ad hoc reports for management, monitoring, and compliance from a ny or all VEHS data. M B1.3 Produce custom reports for management, monitoring, and compliance from a ny or all VEHS data. M B1.4 Allow query of any and all VEHS data such as, but not limited to, medica l, counseling, dental, inventory, financial, or demographic. M B1.5 Capture metrics that reflect stages of the workflow associated with each

step of the Volunteer lifecycle. M B1.6 Provide the ability to export query and report results to, at a minimum, MS Office formats. M B1.7 Be able to save and reload report templates. H B1.8 Capture and report survey data and provide reporting tools for analyzing survey data. M 2. Service Oriented Architecture (SOA) The VEHS shall: Number B2. SOA Description Priority B2.1 Provide a continuous workflow infrastructure for all business processes of the VEHS. M B2.2 Enable flexible and comprehensive exchange of data between and among Pos ts, Regional Recruitment Offices, Headquarters and external parties. M B2.3 Provide electronic interfaces that can be accessed by designated users i nternal and external to Peace Corps with appropriate rules and privileges. M B2.4 Provide portals that integrate with the VLMS portal and present to the e nd user a unified look and feel. M B2.5 Support single sign-on capability. M B2.6 Interface with the Peace Corps' enterprise service bus. (See Section C 5.2 .3, Table 4) M B2.7 Have recommend service use and service development governance policies s upplied by the Contractor that meet the terms of Peace Corps business rules. M B2.8 Institute strict service integration and SOA governance so that services are not directly connecting to databases and underlying business codes are not exposed. M B2.9 Provide SOA services with the capability to tolerate fault; fault recove ry mechanisms shall be automated. M B2.10 Provide a system where the overall set of services, definition of respon sibilities and boundaries are defined and managed. M B2.11 Require contractor to notify service providers and take corrective actio n within time as agreed upon in SLA, when service performance is not met. M 3. General Technical Requirements Provide a modern, secure system of architecture that will meet and adapt to gove rnmental standards and Agency requirements for information management. The Contractor shall: Number B3.1. General Technical Requirements Description Priority B3.1.1 Provide an industry-leading commercial-off-the-shelf (COTS) system to ac hieve the goals and objectives of the Volunteer Electronic Health System as desc ribed in Section C. M B3.1.2 Provide a system that allows Peace Corps to control the workflow. M B3.1.3 Support multiple sources of contact information. M B3.1.4 Provide a system that retains core information as defined by Peace Corps policy guidelines. M B3.1.5 Enable automatic email notification to internal and external users. M B3.1.6 Provide service load balancing so that latency and demand spikes created by integration are effectively and efficiently managed. M B3.1.7 Provide services that have the ability to adjust and manage large and sm all throughput. M B3.1.8 Provide a system that complies with industry standard database design an d interface with Peace Corps data in a secure standardized format. M B3.1.9 Provide a system that allows configurable user interfaces. H

B3.1.10 Provide a system that allows user-configured preferences. H B3.1.11 Provide a system that stops invalid work in progress and guide users to enforce data integrity. M B3.1.12 Provide a system that validates information at different levels of opera tion. M B3.1.13 Provide a system that has the ability to effectively manage bandwidth re strictions due to Peace Corps' technological environment. See Section C, 2.5. Curr ent Physical Environment and Attachment 5, Post Infrastructure. M B3.1.14 Provide a system that operates in a variety of contexts of use, such as geographic locations, with differing numbers of servers, and changes in web and application servers. M B3.1.15 Provide a system that has the ability to monitor and adjust storage and processing capacity to accommodate increasing numbers of users and increasing bu siness volume in critical database tables without slowing operations. M B3.1.16 Provide a system that has the ability to support electronic signatures. M Number B3.2. Portals Description Priority B3.2.1 Provide a fully integrated secure web-based self-service capability with appropriate rules and privileges. M B3.2.2 Support the ability to create a consistent graphical look and feel. M B3.2.3 Provide a list of browser versions compatible with the VEHS. H B3.2.4 Enable portals to integrate with other systems through the ESB. M B3.2.5 Provide portals that support single sign on. M Number B3.3. Compliance Description Priority B3.3.1 Provide an integrated system that is secure and complies with Federal HI PAA requirements. M B3.3.2 Provide an integrated system that complies with Federally mandated crite ria, certification, and security requirements for ePersonal Health Information ( ePHI) covered by HIPAA, HITECH and other DHHS regulations. M B3.3.3 Provide an integrated system that meets and complies with government req uired security standards as described in Special Publication 800-53 See Section C 5.2.5. M B3.3.4 Support organizing data across HHS Electronic Transaction Standards 45 C FR Part 162. M B3.3.5 Meet all legal requirements as specified in Section 508 of the Rehabilit ation Act. M B3.3.6 Notify designated Peace Corps staff in the event security violations occ ur in accordance with the Peace Corps Incident Response Plan. M B3.3.7 Ensure the VEHS complies with Peace Corps HIPAA notification and authori zation requirements. M Number B3.4. Hosting Description Priority B3.4.1 Provide a turnkey hosting solution in accordance with Section C, 5.2.7 t hat provides a reliable solution taking into consideration all of Peace Corps' tec hnical environments (Attachment 5: Post Infrastructure). M B3.4.2 Provide at least one physical environment separate from production for P eace Corps testing and training. M B3.4.3 Provide customer service support to address 24/7 operations in accordanc e with the agreed upon SLA. M B3.4.5 Assist appropriate Peace Corps staff to control, manage, and modify the VEHS if hosted on Peace Corps equipment at overseas locations. M B3.4.6 Provide web site metrics associated with performance for all hosting sit es. H B3.4.7 Provide interfaces to dynamically accommodate worldwide timezones. H B3.4.8 Ensure that all hosting sites meet FISMA security requirements as specif ied in Section C, 1.1. M

B3.4.9 Provide virus and malware scanning and protection service. M B3.4.10 Hosting site shall support encrypted transaction through a secure server such as Secure Socket Layer (SSL). M Number B3.5. Training Description Priority B3.5.1 The contractor shall propose training solutions that meet the requiremen t listed in Section C, 5.2.8 for implementation of the new VEHS. M B3.5.2 The contractor shall propose training solutions that meet the requiremen t listed in Section C, 5.2.8 for ongoing training of new users after the impleme ntation. M Number B3.6. Implementation Description Priority B3.6.1 Provide a detailed implementation plan that meets the goals and objectiv es of the VEHS outlined in Section C. M B3.6.2 Provide a detailed implementation plan that meets the schedule outlined in Section C, 5.2.9. M B3.6.3 Provide a description of the implementation plan to be used to ensure co mpatiblity with the enterprise service bus. See Section C, 5.2.3. M B3.6.4 Provide a detailed implementation plan that complies with Peace Corps re view and testing standards. See Section C and refer to SDLC Handbook, Attachment 6. M B3.6.5 Provide a detailed implementation plan that provides a description of th e Contractor's development/implementation methodology. M B3.6.6 Provide a detailed implementation plan that describes its business trans formation process. M B3.6.7 Describe methodology for migrating data from legacy systems to the propo sed system. M B3.6.8 Provide a detailed implementation plan that describes methodologies for testing the proposed system during various phases of the contract. M Number B3.7. System Upgrades Description Priority B3.7.1 Provide documentation and implementation procedures, for all software up date and upgrades as well as changes and released patches. See Section C, 5.2.9. M B3.7.2 Perform or assist Peace Corps to perform all IT VEHS administration func tions, including installing, testing, VEHS maintenance and upgrades. M B3.7.3 Obtain written approval from the COTR prior to implementing any software upgrades. M Number B3.8. System Controls Description Priority B3.8.1 Provide recommendations on a full set of service level agreements that s hall meet all aspects of the business and technical requirements as outlined in Appendix A and Appendix B of this solicitation. At a minimum, the recommended Service Level Agreement (SLA) shall provide soluti ons to the following requirements. Availability: · The system must be available to users a minimum of 99.5 % of the time. · All web page transaction responses must fall below three seconds for 90% of tran sactions. · No VEHS outage shall exceed one hour per incident and two repeated outages per s ervice year. · Required service uptime is 24/7 365 days except maintenance down time as agreed in the service level agreements. Support: · Contractor shall have customer service staff to address a 24/7 operation need. · Support resolution must assure no interruptions of service and loss of data.

Response: · Contractor must resolve users' help desk requests on production system within 24 h ours of a business day. · Application / System Interface bugs must be corrected within 24 hours but not to exceed 48 hours. For support resolution requiring more than 48 hours, contracto r must obtain written approval from the COTR. M B3.8.2 Comply with NIST 800-53A Audit Guidelines and maintain audit records in archive files. M B3.8.4 Provide audit controls that support encryption methodology for any recor ds transmitted out of the system. M B3.8.5 Provide a system that allows for the archival of audit records to tape o r other off-site storage media. M B3.8.7 Provide access for designated Peace Corps staff to review the audit trai l records within an agreed time frame. M B3.8.9 Provide a mechanism to track service versions and ensure service compati bility. M B3.8.10 Provide a method to monitor and manage live user activity. M B3.8.11 Provide a method to administer users with different group, profile and u ser level privileges. M B3.8.12 Provide a method to manage administrative user accounts. M B3.8.13 Provide a method to routinely assess, and provide metrics on VEHS reliab ility. M B3.8.14 Provide a method to adjust scheduled down times as business requirements change and per Peace Corps requirements. M B3.8.15 Provide a method to maintain required uptime as described in the agreed upon service level agreement. M B3.8.16 Provide a method to limit maintenance down time within mutually agreed S ervice Level Agreement. M B3.8.17 Provide a method to automate all monitoring activities; ensure that all are supplemented with manual examinations of each server on an agreed-upon basis . Monitor availability, response time for key features, and CPU and memory util ization of each server. M B3.8.18 Provide a method to add and make adjustments to the database without neg atively affecting database operations. M B3.8.19 Provide a method to handle large loads of concurrent activities, from mu ltiple internal and external systems. M B3.8.20 Provide a method to manage changes, and consequences of changes, within the VEHS. M B3.8.21 Provide a method to maintain proper testing metrics to ensure that chang es do not break existing system or degrade performance. M B3.8.22 Provide and maintain documentation on VEHS maintenance. M B3.8.23 Work in collaboration with the Peace Corps enterprise disaster recovery plan to develop, test and implement a comprehensive VEHS disaster recovery plan. This disaster recovery results shall be provided to the COTR annually. M B3.8.24 Provide documentation on disaster recovery plans. M B3.8.25 Build the platform on standard commercially available technologies. M Number B3.9. Help Desk Description Priority B3.9.1 Provide assistance to Peace Corps Help Desk support for 24/7 web service in a mutually agreed upon SLA. M B3.9.2 Provide web-based self service technical resource for rapid diagnosis an d resolution of common user errors. H B3.9.3 Create and maintain a repository of technical resources with an interfac e to create and update self service solutions for commonly generated customer se rvice requests. H B3.9.4 Provide problem analysis and resolution to a submitted service request i n accordance with the agreed upon SLA. M B3.9.5 Provide Help Desk response prioritized by the severity of the problem in

accordance with the agreed upon SLA.

M

Contents SECTION C 3 1.0 Volunteer Electronic Health System Overview 3 1.1 Goals of VEHS 3 1.2 Functional Components of the Volunteer Electronic Health System (VEHS) 3 1.2.1 Practice Management System (PMS) 3 1.2.2 Electronic Health Record (EHR) 3 1.2.3 Clinical Decision Support System (CDSS) 3 1.2.4 Pre-Service Module 3 1.3 The VEHS On-Boarding Intersection 3 1.4 VEHS and the Volunteer Delivery System 3 2.0 PEACE CORPS: BACKGROUND 3 2.1 Agency Background 3 2.1.1 Office of Volunteer Support Background 3 2.2 Description of Users 3 2.3 Number of Users 3 2.4 System Capacity 3 2.5 Current Physical Environment 3 2.5.1 Domestic Operations 3 2.5.2 International Operations 3 2.6 Current IT Infrastructure Development Standards 3 2.7 Current IT Infrastructure 3 2.8 Current Architecture 3 2.9 Office of Volunteer Support: Current Operations 3 2.9.1 Pre-Service (medical clearance) 3 2.9.2 In-Service 3 2.9.3 Post-Service 3 2.9.4 Medical Records 3 2.9.5 Program Analysis and Epidemiology (Report & Analysis) 3 2.9.6 Program & Training 3 2.9.7 Quality Improvement (QI) 3 2.9.8 Office of Special Services (OSS) 3 2.9.9 Health Information Systems (HIS) 3 3.0 Current Volunteer Support Medical Challenges 3 3.1 Customer Service Challenges 3 3.2 Information Management Challenges 3 3.3 Administrative User Challenges 3 4.0 VEHS Objectives 3 5.0 General Requirements 3 5.1 Business Functional Requirements 3 5.2 Technical Requirements 3 5.2.1 Service Oriented Architecture (SOA) 3 5.2.2 Peace Corps Specific SOA To-Be Environment 3 5.2.3 System Interfaces 3 5.2.4 Portals 3 5.2.5 Security Requirements 3 5.2.6 Health Care Requirements 3

5.2.7 5.2.8 5.2.9 5.2.10

Hosting Support 3 Training 3 Implementation Plan Help Desk Support

3 3

SECTION C 1.0 Volunteer Electronic Health System Overview The Peace Corps is issuing an RFP seeking a Contractor to provide industry-leadi ng commercial-off-the-shelf (COTS) software to develop and upgrade the core busi ness systems and processes required to manage all aspects of Volunteer health. T he RFP focuses on the development of a Volunteer Electronic Health System (VEHS) that includes the following components: · Practice Management System (PMS) · Electronic Health Record (EHR) · Clinical Decision Support System (CDSS) for medical staff In addition, Peace Corps is seeking a module to automate the medical clearance o f applicants for Volunteer service that Peace Corps calls the Pre-Service module . Peace Corps will implement a VEHS that supports the sequential stages of the Vol unteer experience, referred to as the lifecycle of the Volunteer. Included are all the business processes, records, and data that address the comprehensive act ivities associated with all stages of the lifecycle of the Volunteer; from outre ach to potential applicants to those who have finished their service and returne d (Returned Volunteers). Peace Corps is not seeking to simply retrofit its current business processes and existing systems. Peace Corps requires industry leading health care technology and business process reengineering services. Current systems are neither adapta ble nor comprise industry leading workflow systems that engage customer relation ship management or information technology supported healthcare standards. The p roposed system shall include a protected Quality Assurance (QA) function through which authorized users will conduct peer reviews and quality improvement. The selected VEHS Contractor shall enable efficient mission delivery utilizing c ommercial off-the-shelf software, fresh business processes, and workflow systems that require minimum customization to meet Peace Corps' mission. 1.1 Goals of VEHS The overall VEHS shall improve the operation and customer service of the Office of Volunteer Support by achieving: 1. The electronic recording of all medical, mental health and dental data o f program participants throughout the lifecycle of the Volunteer. 2. Linkage of medical units of the Office of Volunteer Support by providing a thorough set of medical data to be used for reporting, research, data-driven management decisions, and informed policy formulation. 3. An improved medical clearance system incorporating a Pre-Service module, with an applicant portal for exchanging information and applying branch-logic, decision-tree automated processing in order to assess applicants. 4. The delivery of automated reminders to applicants, Volunteers and Return ed Volunteers on applicant processing, healthcare delivery, or health benefits i nformation respectively. 5. The implementation of a CDSS to aide medical staff on meeting standardiz ed levels of health care. 6. Performance reliability in the Peace Corps environment including securit y requirements, telecommunication constraints, bandwidth issues, and staffing tu

rnover. 7. Improved administrative management using standard practice management sy stem tools. 8. Protected quality assurance activities with private, recorded peer revie w functionality in order to deliver ongoing quality improvement. 9. All Agency and Federal requirements such as, but not limited to, Health Insurance Portability and Accountability Act (HIPAA), Health Information Technol ogy for Economical Clinical Health Act (HITECH), Department of Health and Human Services (HHS), and Federal Information Security Management Act (FISMA) regulati ons. 10. Compliance with Peace Corps record retention policies, which vary from 1 2 months to 25 years based on lifecycle status. Peace Corps requires a Contractor to introduce a VEHS which meets mission output requirements and identifies modern business processes, together with document h andling ability and proposed infrastructure. The new system shall meet mandated government standards (i.e. HIPAA, FISMA, and HITECH) and Federal agency requirements (see section H). The system shall also b e designed to efficiently and comprehensively cope with changing Agency requirem ents, particularly those dealing with program growth, changes in countries of se rvice, and varying medical protocols. The American Recovery and Reinvestment Act (ARRA), signed into law February 2009 , motivated the healthcare community to become meaningful users of an EHR. Start ing in 2015, all healthcare providers are expected to have adopted and be active ly utilizing an EHR to improve quality and safety, engage patients, improve care coordination, improve public health, and improve security. Many of the qualiti es associated with the ARRA will be adopted by the Peace Corps as it implements a VEHS. According to a short sample of published standards, 75 Fed. Reg. 1844, 1854-58 ( Jan. 13, 2010), the Peace Corps' goals and objectives are consistent with industry standards. They require that the agency: · Implement drug, drug-allergy, and drug formulary checks · Maintain an up-to-date problem list of current and active diagnosis based curren t and future International Classification of Diseases (ICD) codes · Incorporate clinical lab-test results into an EHR as structured data · Generate lists of patients by specific conditions to use for quality improvement , reduction of disparities, research, and outreach · Send reminders to patients per patient preference for preventive/follow-up care · Implement five clinical decision support rules relevant to specialty or clinical priority 1.2 Functional Components of the Volunteer Electronic Health System (VEHS) VEHS shall include the following functional components to address medical, menta l health and dental care (for detailed requirements, please see Appendix A): 1.2.1 Practice Management System (PMS) This system provides tools for practicing healthcare delivery and is typically a n umbrella system that includes the components of an EHR and a CDSS. The PMS bri ngs together the information of all components including: · Diagnosis, procedures, and clinical management practices · Office/medical unit administration, function for appointments, and customer serv ice reminders to patients · Inventory status, recorded medical resources, and supplies utilized to provide c are · Clinical outcomes resulting from health interventions · Separate quality assurance performance section requiring documentation of protec ted peer review activities that can be isolated from the rest of the record and used for standard quality improvement activities · Surveillance tool(s) for information gathering The capture and organization of such data will enable continuous feedback to inf orm management and policy decisions. The ability to report on these data, as no ted in Appendix B, is critical to making agency decisions as well as meeting oth

er external reporting requirements. More importantly, this system shall, through SOA and an ESB, allow for data to b e queried along with the data from other SOA programs linked through the ESB. T he system shall identify correlations between factors such as: · Pre-service medical characteristics and follow-up care delivered in the field · Pre-service medical characteristics and post-service Federal Employee Compensati on Act (FECA) claims · In-service medical care delivered in the field and post-service FECA claims · Medical accommodations and assignments or other program factors · Recorded duration of Volunteer illness and lists of medical conditions 1.2.2 Electronic Health Record (EHR) This EHR shall record the comprehensive medical information from the medical cle arance process including history of diagnosis and treatment, clinical diagnosis and procedures delivered during Volunteer service, and post-service medical stat us. The EHR must be an organized, secure record of personal medical information including, but not limited to, the following: · Tracking of all stages of medical information with International Classification of Diagnosis (ICD), Current Procedural Terminology (CPT), and Current Dental Ter minology (CDT) codes and other relevant HIPAA transaction standards · Prescription history both past and present · Allergies including, but not limited to, food, drug, animal, and insect · An up-to-date problem list of current and active diagnosis · Clinical lab-test results, vaccine history, vaccine requirements · Patient-specific conditions necessary for medically accommodated placements, ep idemiological surveillance, and quality improvement initiatives 1.2.3 Clinical Decision Support System (CDSS) The CDSS shall standardize clinical care rendered by medical staff. The CDSS sh all enable staff to: · Access clinical guidelines and expert diagnostic decision pathways · Provide real time identification of potential errors and possible drug interacti ons · Utilize standardized decision support, and allow input to standardized protocols · Conduct telephone triage 1.2.4 Pre-Service Module The Pre-Service module shall conduct applicant medical screening and automatical ly produce medical clearance qualifications as defined by Peace Corps Medical Cl earance Guidelines, see Attachment 1 for a copy of the index and two sample guid elines. It shall: · Provide interoperability with the Recruitment and final on-boarding systems requ ired for the VLMS through the ESB · Accommodate changes in the medical clearance guidelines and intake process · Issue access to Peace Corps staff per various roles and privileges · Transfer data outputs to the VLMS · Function as part of the Peace Corps on-boarding process and house applicant medi cal information, screening guidelines, and medical resources at Post in order to determine if, when, and where an applicant can serve as a Volunteer · Utilize medical information as early in the process as possible to identify qual ified applicants, or to determine current medical status must be resolved before application can proceed · Deliver excellent automated customer service to those in the Lifecycle process · Provide a workflow to support an appeals process for those applicants who are de termined to be medically not qualified for service as a Volunteer · Automate the medical clearance approval process utilizing industry leading workf low incorporating Agency accepted standard operating procedures · Guide Pre-Service Nurses when appropriate with exceptional administrative decisi on support · Record all medical information into the EHR 1.3 The VEHS On-Boarding Intersection A primary function of Peace Corps is to deliver Volunteers to its operations abr

oad. This requires the cooperation and exchange of data among three Headquarter s operational units and the regional recruitment offices; it covers the recruitm ent of prospects, medical screening of applicants, and the placement of Voluntee rs. This is illustrated in Table 1.

Table 1 Volunteer Delivery System Integration

Peace Corps reviews the health status of applicants before they become Volunteer s in order to ensure that Volunteers will be likely to complete 27 months of ser vice in challenging environments without unreasonable disruption due to health p roblems. Those determined to be medically eligible are given a medical clearance , and their application is sent forward for further, non-medical review. The Peace Corps follows the federal Rehabilitation Act of 1973, as amended, whic h prohibits discrimination on the basis of disability in federal programs or act ivities. Peace Corps uses Screening Guidelines in determining who may be medica lly cleared and whether a medical accommodation is necessary for a particular ap plicant. A medical clearance with a medical accommodation may be of two types: (1) in order to accommodate the applicant's medical conditions, the applicant may be placed only in a country that has the medical resources necessary to accommod ate those conditions; or (2) in order to accommodate the applicant's medical condi tions, the applicant must be placed only at a site with specific individually-re quired conditions, and only in a country with the medical resources necessary to accommodate the applicant's medical conditions. In support of the medical accomm odation, the Office of Volunteer Support has developed Accommodation Lists with country placement (on-boarding) options for common medical conditions. See Samp le Accommodation List, Attachment 2. The Pre-Service module shall improve the delivery of Volunteers by enabling a be tter medical screening process which shall also capture appropriate medical data and populate an EHR that meets modern healthcare technology recommendations. I n addition, the Pre-Service module shall incorporate a match between manageable medical conditions of an applicant and the corresponding Posts that have the med ical resources to accommodate the condition. The Pre-Service Module shall also identify the applicants who may require site-specific medical accommodation, and through system interoperability, support further program on-boarding tasks. The VEHS must address the task of on-boarding the applicant with a successful me dical clearance process. It must also function throughout the lifecycle of the Volunteer by populating the EHR with the data necessary for In-Service Nurses an d medical staff at Posts to deliver healthcare services, and for Post-Service Nu rses to coordinate health benefits on an authorized basis for Returned Volunteer s. A highly functioning Pre-Service Module shall meet the goals and objectives stat ed in order to create an EHR that: · Will be used throughout the lifecycle of the Volunteer · Contribute to the data, Quality Assurance, and reporting capability of the overa ll VEHS · Utilize a workflow engine that conducts medical screening for Peace Corps Volunt eer service. 1.4 VEHS and the Volunteer Delivery System The Volunteer Delivery System (VDS) is the overarching set of systems that enabl e Peace Corps to process, track, and keep records of applicants, of those who be

come Volunteers, of Volunteers who serve, and of Volunteers who finish their ser vice and become Returned Volunteers. The VEHS shall recognize stages of Volunte er service such as but not limited to application status, Volunteer status, and Returned Volunteer status. The VDS system will be branded by Peace Corps as the DOVE system (Database of Vo lunteer Experience). The existing VDS is a patchwork of paper-based and electronic systems developed over many years and requires a comprehensive revision in order to meet new gover nmental IT and privacy requirements, and to cope with anticipated program expans ion. The current systems that comprise the many functions of Volunteer delivery proce ssing and support evolved without developing overall system integration goals. It is referred to as the Volunteer Delivery System, even though it has few attri butes of a single highly-functioning system. The existing systems provide variou s critical contributions to the mission of the agency, but create paper or busin ess process burdens due to a lack of integration, and the evolution of systems a nd processes. Various systems exist to serve the steps of on-boarding, medical and non-medical program support, and post-service activities. As a result, the Peace Corps seeks to reinvent and improve business processes with industry-leadi ng COTS systems to support its mission. In addition to this RFP, the Peace Corps has issued an RFP for a Volunteer Lifec ycle Management System (VLMS). For more information on the stages of the Volunt eer lifecycle, please see Peace Corps Volunteer Delivery Lifecycle, Attachment 3. Selected Contractors shall work together in cooperation with Peace Corps to integrate the VLMS and the VEHS, utilizing Service Oriented Architecture (SOA) and the new ESB, which is under construction. 2.0 PEACE CORPS: BACKGROUND 2.1 Agency Background President Kennedy formed the Peace Corps with an executive order on March 1, 196 1 and in 1979, it was made a fully independent agency. Since its founding, Peac e Corps has served in 138 developing countries, and nearly 200,000 American citi zens have served as Peace Corps Volunteers (PCVs). The Peace Corps has approxim ately 2000+ employees, 800 of whom work in the United States at headquarters in Washington DC and in 9 regional recruiting offices, and 1200 who work in our Pos ts throughout the world. The Peace Corps  mission has three simple goals: 1. Helping the people of interested countries in meeting their need for tra ined men and women. 2. Helping promote a better understanding of Americans on the part of the p eoples served. 3. Helping promote a better understanding of other peoples on the part of A mericans. Peace Corps, through the Office of Volunteer Support, is responsible for the coo rdination, management, and oversight of all medical, mental health and dental ca re of individuals enrolled as Peace Corps Trainees, Volunteers and Returned Volu nteers who are recipients of FECA health benefit claims through either the Peace Corps or the Department of Labor (DOL). Peace Corps supports Returned Voluntee rs by coordinating health benefits, on an authorized basis, for some health issu es that arise or are exacerbated during Volunteer service. Peace Corps Volunteers typically serve at a ªgrassrootsº level and the program curre ntly operates in over 75 countries. In order to become a Volunteer, each applic ant must meet skill, suitability, medical, and legal criteria before assignment to a Peace Corps office, or Post, abroad. Approximately 8,000 Volunteers are cu rrently serving around the world. See the Peace Corps website www.peacecorps.go v for more information. 2.1.1 Office of Volunteer Support Background The Office of Volunteer Support, with approximately 70 staff at headquarters, ha s three core medical units: · Pre-Service: applicant medical clearance; delivers administrative decisions

· In-Service: direct healthcare delivery, and coordinated support · Post-Service: manage Returned Volunteer health benefit claims Additional units include the following: · Program and Training Unit (PTU): trains Peace Corps medical staff · Office of Special Services (OSS): mental health specialists · Health Information Systems (HIS): support operations · Office of Program Analysis and Epidemiology: health surveillance and outreach · Quality Improvement (QI): clinical and technical monitoring · Medical Records: management of paper files, mail, movement of records, security of records, and other related responsibilities Each Post is staffed by one or more medical professionals. There are currently 130 medical professionals at Peace Corps Posts. These medical professionals are in charge of unique health units which provide healthcare to Volunteers. Some Posts are in resource-challenged environments where electricity and bandwid th are unreliable and latency is variable. Offices at overseas Posts are located in major cities, but Volunteers are placed in both urban and rural environments. Communication between and among headquar ters, regional recruitment staff, including field-based and contract recruiters, Posts, Volunteers, and Returned Volunteers must function within this context. 2.2 Description of Users Users of this system will be both internal and external. Internal users are hea dquarters and field staff. External users are the applicants, Volunteers, Retur ned Volunteers, and healthcare providers who may supply information to the syste m. Users will include: Headquarters Medical Staff · Pre-Service ± collects and assesses clinical information from applicants and their providers including medical, mental, and dental to make an administrative deter mination on medical qualification and medical placement determination, deferred medical clearance processing, or medically not qualified · Dentist ± determines dental clearance for eligibility to serve as Volunteers, rec eives x-rays and dental charts from applicants or dental providers · In-Service ± Nurses support medical staff in the field to coordinate clinical and administrative determinations, manage medical evacuees in Washington, D.C. and e lsewhere and provide support to pre-departure gatherings of groups of entering V olunteers called Trainees · OSS/mental health specialists ± deliver mental health services for case-specific r eview in Pre-Service, and for In-Service cases · Post-Service ± manage healthcare benefits to Returned Volunteers with medical clai ms to the Peace Corps or the DOL. · Office of Program Analysis and Epidemiology ± conduct formal surveillance of clini cal diagnosis and related activities, and deliver various outreach initiatives o n public health issues · Quality Improvement ± monitor and publish ongoing clinical requirements for health care delivery, monitor and develop ongoing medical clearance guidelines for medi cal and mental health clearance, oversee quality assurance and improvement Headquarters Administrative Staff · Administrative tasks include training, contract management of healthcare service s, interdepartmental projects, medical records management, customer service, pro viding support to clinical staff, and accessing records Post Medical Staff · Manage a stand-alone medical unit requiring practice management administered by one or more medical staff · Coordinate healthcare services with In-Service staff in Washington, D.C. and wit h local providers · Usually located with the Post Administrative Unit and are part of the Administra tive Unit infrastructure Post Administrative Staff · Located in the capital city of the country where Volunteers live and work · Have a stand-alone physical infrastructure that includes telecommunication tools and a networked computer system

· Support medical staff in the medical practice unit and by monitoring administrat ive activity Applicants · Provide medical history, current medical information, and other medical clearanc e data as determined to Pre-Service staff · Need to know: the individually-required materials to submit as soon as possible for medical clearance, medical clearance processing status at all times, and be managed to meet program departure deadlines Volunteers · Volunteers live and work at sites that are not located near the Post Administrat ive Units and are not part of the Administrative Unit infrastructure · Are not necessarily located near their medical staff who are usually in a major or capital city · Require communication with medical staff and need to receive reminders, directiv es or other healthcare information during service in the field Returned Volunteers · Require exchange of information to support health benefit claims with the Peace Corps or the DOL · May require short-term, long-term or lifelong benefits External Providers · Doctors, dentists, and counselors who are not Peace Corps staff · Any source that supplies other medical information, such as lab results 2.3 Number of Users Applicants who could utilize a medical system portal for processing may range 10 ,000 ± 20,000 per year. Volunteers in the field who could communicate and access information with medical staff may range 8,000-16,000 per year. Our users are lo cated in 75 Posts throughout the world and at Peace Corps Headquarters in Washin gton D.C. Headquarters clinical staff · 5 or more doctors · 5 nurse managers · 30 or more nurses · 5 or more mental health counselors · 1 dentist Headquarters administrative staff · 4 administrative managers · 20 or more administrative staff Field based clinical staff · More than 130 PCMOs Field based administrative staff · More than 225 administrative, approximately 3 per post Applicants · Approximately 10,000-20,000 per year Volunteers · Approximately 8,000-16,000 per year RPCVs · Approximately 28,000 cases are currently open representing all ongoing claims si nce 1961, while approximately 600 are added each year 2.4 System Capacity Over 180,000 individuals contact the Peace Corps each year expressing an interes t in Volunteer Service. In fiscal year 2009, 15,386 individuals completed an ap plication to serve in the Peace Corps. This application included a medical hist ory form. See Medical History Form, Attachment 4. Recruitment preliminarily asse ssed and then interviewed approximately 63% (9,706) of these applicants. From t his group, a subset of 52% (7,900) of the total number of applicants were recomm ended by recruiters for further application processing. The Pre-Service Unit conducts medical clearance on all recommended recruits. Of those who complete the medical clearance requirements: · Approximately 5% are medically not qualified; · Approximately 10% are medically deferred until a condition becomes stable and me

dical clearance resumes at a later date; · Approximately 45% are qualified to be placed at any site in any country; · Approximately 35% are qualified for any site in a country that has resources whi ch can support their unique medical history and status; · Approximately 5% are qualified for an unknown number of sites which may meet spe cific, individually required conditions and within a country that has resources which can support their unique medical history and status. Currently, 15-30% of all recommended recruits do not complete the application pr ocess. Some applicants who receive a medical clearance drop out before on-board ing; and some medically-cleared applicants are rejected on the basis of skills o r suitability issues during later stages of on-boarding, currently managed in th e Placement Office. Typically, our existing processes demonstrate the following metrics: · If the Peace Corps requires 1,000 Volunteers, then it must recommend 1,800-2,000 applicants for further processing in order to medically clear 1,300. The system must operate without regard to the volume of applicants, Volunteers, and Returned Volunteers and be scalable to changes and variations in the number of program participants, posts, regional offices, and medical protocols. 2.5 Current Physical Environment 2.5.1 Domestic Operations · Headquarters Office The Peace Corps headquarters office is located in Washington, D.C. and coordinat es and supports regional and international field operations. Approximately 800 e mployees work in this office. · Regional Offices There are nine Regional Recruiting Offices: Atlanta, GA; Arlington, VA; Boston, MA; Chicago, IL; Dallas, TX; Los Angeles, CA; New York, NY; San Francisco, CA; a nd Seattle, WA 2.5.2 International Operations Peace Corps Posts are spread out world-wide amongst three administrative regions : Africa; EMA (Europe, Mediterranean and Asia) and IAP (Inter America and Pacifi c.) Typically, the central office at a Post is located in the capital city of e ach host country. Volunteers are often placed in remote, rural locations, witho ut access to electricity. It is not unusual for them to be a large distance fro m the central office, although some Volunteers work in towns or urban settings. Posts conduct program activities under diverse physical and technical condition s. However, most Posts, including their rural locations, thrive with texting te chnology which is widely adopted by Volunteers and staff. See Post Infrastructu re, Attachment 5. 2.6 Current IT Infrastructure Development Standards Current IT infrastructure is defined in Current Architecture, paragraph 2.7 belo w. For Peace Corps system development standards please refer to the Peace Corps' Systems Development Lifecycle (SDLC) Handbook Version 4.2. See SDLC Handbook, A ttachment 6. The SDLC outlines the policies, standards and lifecycle that gover n information technology systems at Peace Corps. The SDLC represents the entire lifecycle of Peace Corps' system development and is the framework that requires ta iloring for implementation. The contract will be focused on the control phase of the SDLC that includes: Project Definition, System Design, Construction, Accep tance, and Operational Readiness. The control phase may consist of multiple ite rations and should follow either a spiral or agile methodology of system develop ment. 2.7 Current IT Infrastructure Over the past 20-plus years, Peace Corps information systems and technology has incorporated a variety of platforms, system owners, and functions to support var ious activities at overseas Posts and all domestic locations. Recent initiatives have included examples such as the following: a financial system (Odyssey), an overseas infrastructure system (GSS 3.0), and databases for in-service Voluntee rs (VIDA). See Volunteer Delivery System Models, Attachment 7 and Enterprise A rchitecture Systems Map, Attachment 8, which depict current systems and platform s.

Some of these systems have been built in a piecemeal fashion that reflected shif ting priorities, available funding, and current technology. See Table 2. Roughl y four eras of technology can be identified. While the earliest period, Mainfra me, had been successfully migrated to other systems, Peace Corps maintains three separate periods of software and systems development. Even with the latest iterations of Peace Corps IT systems to support the medical mission, the current system remains primarily a paper and process-based system. Assistive/automated workflows are not well implemented, if at all, and much in formation resides outside of any IT system in file folders and cabinets and in l ocally developed spreadsheets created by individual offices or Posts. Table 2 Era Mainframe PCApps BizApps .NET/Aquifer Data Tier Mainframe Oracle UNIX/Windows Oracle UNIX/Windows Oracle Windows SQL Server Oracle Application Tier ColdFusion .NET/Aquifer Presentation Tier Dumb Terminal Thick Client Oracle Forms Web Forms Smart Client ASP .NET Time 2.8 Current Architecture The Peace Corps Segment Architecture consists of eight systems spread amongst th ree segment areas. The segments are illustrated in Table 3. · Core Mission Area Segments consist of the Volunteer Delivery and Support System (VDS), Medical Services, and Post Services. · The Business Services Segments consist of Human Resources, Financial Systems and Inspector General Systems. · Enterprise Services consist of the Global Network and Global Infrastructure whic h includes Domestic, IAP, EMA and Africa. The Peace Corps Technical Architecture is predominantly made up of Wintel system s. Windows XP is the desktop operating system and Windows 2000, 2005 and 2008 p hysical and virtual servers reside in the on-site data center. Additionally, th ere are several HP-UX and Linux systems in the on-site data center. Peace Corps maintains a disaster recovery site outside of Washington DC. Databases include Oracle 10i and Microsoft SQL Server 2000, 2005 and 2008. Many , if not all, business units and overseas Posts maintain their own Access and Ex cel-based data. File and print services are managed via Windows 2005 and 2008 s ervers. Active Directory (AD) is in place and a single AD structure is being im plemented at all overseas Posts connected to the Peace Corps global network. Mi crosoft SharePoint is currently in the Peace Corps environment. Approximately a third of all Posts (all of IAP and a few Posts in EMA and Africa ) are integrated into the Peace Corps global network via VPN using Cisco's Wide Ar ea Application Services (WAAS). The WAAS provides both security and WAN acceler ation. The remaining Posts are disconnected from the Peace Corps global network on their own un-trusted domains. However, they are connected to the Internet vi a either local ISP and/or VSAT. VSAT is predominantly used in Posts in Africa. Overall, the architecture allows business-related communication by all Posts to HQ via custom-built applications. Peace Corps Systems have been developed using Oracle Forms, ColdFusion, Java, J2 EE & .NET. Users in the US and at Posts typically have multiple logins to acces s different systems. Single sign-on has yet to be implemented.

Table 3

2.9 Office of Volunteer Support: Current Operations The Office of Volunteer Support delivers all medical aspects of the Peace Corps mission including dental and mental health. See Medical Services IT Systems, At tachment 9. 2.9.1 Pre-Service (medical clearance) All Peace Corps applicants must go through a medical, mental health and dental r eview process before being cleared for service. The review process is carried o ut by the Pre-Service Unit in Volunteer Support. 2.9.2 In-Service 2.9.2.1 Staging Staging is the first physical gathering of accepted applicants for departure to an overseas program, and for healthcare to commence at the post medical unit. T he first day of Staging is the first official day of Peace Corps service. Oversi ght of the health and well-being of Volunteers begins with the applicant's departu re from home to report for Staging. 2.9.2.2 Post Medical Units Peace Corps supports the health of the Volunteer by providing a Medical Unit at each Post led by at least one Peace Corps Medical Officer. A Post medical unit is analogous to a clinic, although the Peace Corps health units vary in the serv ices they can provide, or refer Volunteers to in their respective (local) medica l communities. Medical staff duties include the following: · Provide healthcare services to Volunteers in-country · Maintain the EHR by documenting relevant actions that take place during Voluntee r service · Assess local health resources to maintain a country health resource database for the medical accommodation placement process · Print the scanned medical record from a CD to create a paper medical record for each Volunteer arriving at Post · Maintain a small office pharmacy and inventory system · Coordinate care with local healthcare providers · Communicate with Volunteers and headquarters staff regarding health care issues via email, fax and telephone, including text messages and regular mail · Contribute to the monthly Epidemiological Surveillance System by reporting Train ee/Volunteer health data to the Office of Program Analysis and Epidemiology Unit . See Monthly Surveillance Survey/TG410 ESS Report Form, Attachment 10. 2.9.2.3 Field Support Nursing The primary role of the Field Support Nurses, based in Washington, DC, is to mai ntain Volunteer health by supporting medical staff at Post and managing cases of Volunteers who are medically evacuated to Washington, DC or other locations. Ac tivities include coordinating care, visiting and evaluating Medical Units and Vo lunteer sites, consulting in-house or with panel specialists, reviewing medical records, and formulating health care guidance and disposition. Health care needs that exceed the capability of in-country resources result in a medical evacuation (medevac) of Volunteers from their Posts. Medevac facilities are located in the United States and other countries. Medical staff exchange cr itical information and update the status of medevacs via secure email and fax sy stems. In-Service Nurses provide 24-hour support coverage to medical staff via e mail and phone. 2.9.3 Post-Service The primary business of the Post-Service Unit (PSU) is to assist Returned Volunt eers with Post-Service health benefits documentation and processing. The scope o f services Peace Corps provides is largely limited to claims by Returned Volunte ers under the Department of Labor's (DOL) Federal Employment Compensation Act (FEC A) program. This requires communication among the Returned Volunteer, the DOL, t he PSU and any external contractors. See 127-C Form, Attachment 11. The PSU re lies upon the all documentation from the Pre-Service and In-Service Units to pro cess claims made by Returned Volunteers. The current case management system of the PSU incorporates data uploads from the DOL. See DOL Data Elements & DOL Dat a Load SOP, Attachments 12 and 12b. 2.9.4 Medical Records

The Medical Records Unit manages all health records and releases medical informa tion to authorized providers and individuals. The core functions of the Medical Records Unit are the creation, distribution, tracking, and archiving of Voluntee r health records. The current system for creating medical records requires manual collation of inf ormation gathered in Pre-Service, scanning all paper documents and then burning compact discs that contain an Applicant's entire medical record for each country. Other responsibilities include the maintenance and monitoring of health record p olicies and procedures. This includes providing copies of health information up on request from Applicants, Volunteers and Returned Volunteers. The Peace Corps retains records for 12 months to 25 years as required by Peace Corps policies. 2.9.5 Program Analysis and Epidemiology (Report & Analysis) The Program Analysis and Epidemiology Unit develops, maintains, and analyzes hea lth surveillance systems. The core functions of the Program Analysis and Epidemi ology Unit are to provide oversight of health surveillance of Volunteers through the Epidemiological Surveillance System and other health surveillance systems, conduct studies to analyze health conditions and identify risk factors for certa in conditions among Volunteers, and assist in the design of prevention strategie s. Due to the limited and stove-piped nature of the systems currently in use in the Office of Volunteer Support, the Program Analysis and Epidemiology Unit is curr ently limited in its ability to analyze data without significant manual labor. See Attachment 10 for a copy of the Monthly Surveillance Survey, which is comple ted manually by medical staff worldwide, and processed manually by the staff of the Program Analysis and Epidemiology Unit. 2.9.6 Program & Training The Program and Training Unit (PTU) provides oversight of headquarters-sponsored training events for the medical staff worldwide. This unit will be involved in the training of the medical staff on the new VEHS. The PTU manually tracks the credentials of all medical staff along with their annual training attendance. 2.9.7 Quality Improvement (QI) The Quality Improvement Unit develops health system policies, monitors the effec tiveness of health care to Volunteers, and provides information and analysis on health conditions and programs. The core functions of the Quality Improvement Un it are to develop, disseminate, and monitor medical policies and procedures. 2.9.8 Office of Special Services (OSS) The Office of Special Services (OSS) assists Posts in the management of Voluntee r behavioral and adjustment challenges through telephone and secure email consul tations. The OSS also provides input into the mental health medical clearance of applicants, conducts direct mental health medevac support, and consults as nece ssary on mental health support. 2.9.9 Health Information Systems (HIS) The Health Information Systems Unit provides support to the existing health info rmation infrastructure of the Office of Volunteer Support. The HIS gathers and r eports information and data of private health insurance contracts utilized by re turned Volunteers. The HIS also engages in tracking, usage and updating of busin ess and medical forms. It facilitates receiving Returned Volunteer case managem ent information from the DOL, and providing data in appropriate formats to healt hcare service partners. 3.0 Current Volunteer Support Medical Challenges 3.1 Customer Service Challenges · Many information technology tools have been developed in a piecemeal and stove-p iped environment resulting in independent databases that span many technological platforms. Consequently, customers must supply the same information to differe nt staff units and the data is not systematically shared. · The system does not allow for capturing and recording customer satisfaction feed back that will assist with improving processes. · The current systems do not allow applicants, Volunteers or Returned Volunteers t o monitor the medical information requests made to them, the responses to those requests, the follow-up required of them, and the overall status of their proces

sing with Peace Corps. · The various systems do not have substantial customer relationship messaging. Co nsequently, the volume of telephone calls from customers regarding the status of their processing in any work unit is very high. · The current Pre-Service technology and business processes complicate the applica tion experience and may contribute to a high attrition rate among applicants. 3.2 Information Management Challenges · There is no electronic system in which to house or enable peer review QA activit ies. · Clinical staff must access multiple systems to access information related to the same medical record. · The Pre-Service IT system is not programmed to automatically approve or highligh t irregular and/or out-of-range medical test results submitted by the applicant. · The Pre-Service IT system does not automatically apply the medical clearance gui delines to the evaluation of applicant medical information. · The In-Service system does not aid the In-Service Nurse with practice management technology in order to monitor the adherence to required healthcare delivery st andards. · The In-Service system does not have tools to manage medical appointments and con sultation scheduling. · The medical staff in the field has no electronic medical system. · The diverse systems within the medical units sometimes overlap in function, but do not interface to produce an EHR or integrated workflow with shared business p rocesses. · The current systems do not have performance related standards or decision suppor t built in to assist users in clinical decision making. · The current system does not allow for mental health consultations to be recorded . · The current operation does not have a medical inventory control or cost tracking system for Post or staff performing central procurement services at headquarter s. · The data in current systems is not easily electronically available for epidemiol ogical use or QI. 3.3 Administrative User Challenges · Numerous systems increase maintenance work of administrative and IT staff. · The Pre-Service IT system does not have the ability to assess the completeness o f a file, thus requiring repeated manual handling and ªpre-screeningº to determine m aterial completeness. · Because the system has no ability to determine if all the materials have been su bmitted, the unit cannot predict productivity or respond to alternative plans to support program intake goals. · Information from medical staff is collected only via paper processes, fax, and e -mail. · The sharing of information between various medical delivery and support units is not possible because the systems are not directly linked and do not constitute a single connected, workflow system with data feedback. · Under the Peace Corps Act, federal employees of the Agency are term-limited to f ive years. The ªfive-year ruleº results in significant staff turnover and reduces i nstitutional knowledge and memory. Consequently, the current environment is satu rated with unique legacy systems. · As health conditions change in applicant populations, the current system is not able to capture those changes in a timely and systematic manner to adjust missio n deliverables such as: medical clearance guideline changes; medical staff trai ning; expense calculations; placement accommodations; QI policy discussions; and /or management decisions. · Peace Corps has over 75 overseas Posts interconnected through a distributed wide area network (WAN); many suffer from low-bandwidth, high-latency connections an d inconsistent electrical supply. · The medical factors of placement eligibility are not currently available to recr uiters during the recruitment and application phase when applicants begin to dev

elop program expectations, including possible geographic placement. Approximate ly 40-50% of those who complete the medical clearance process have a placement-r elated accommodation contributing to a change in placement options. This contri butes to applicant drop-out and expenditure of agency resources during the recru itment, medical and placement processes. · Without automation tools for reasonable customer messaging, the requirements of the current process are often underestimated by applicants, who may be cleared l ater than desired. · The current system does not capture key performance metrics. · The current system does not track or report medical supply usage and related cos ts. 4.0 VEHS Objectives Peace Corps requires an electronic system and new business processes to constitu te a VEHS that includes a Pre-Service module. The Peace Corps can not interrupt the on-boarding of Volunteers or the delivery of medical support or care. Peac e Corps requires an automated system with document handling ability, as describ ed throughout this solicitation, and anticipates new business processes to acco mmodate COTS products, with minimum customization. Peace Corps requires simpler processes and industry-leading approaches such as ªOHIOº (Only Handle It Once ), wh ich can be applied to the Pre-Service module or Post-Service case management dut ies in order to know when the Peace Corps customer has submitted all of the info rmation necessary for administrative determinations to proceed. When complete, the new system shall be an industry-leading system that creates p ositive, clear, well-communicated processes for applicants, Volunteers, and Retu rned Volunteers. For example, the new Pre-Service module shall identify eligibl e applicants as early as possible by providing the applicant with a process that transparently delivers results without undue expense, expectations, or investme nt by the applicant or the Agency. The new system shall allow Peace Corps to monitor medical staff performance, and record compliance and exceptions to compliance. It shall have an isolated Qual ity Assurance performance section to conduct protected peer review activities le ading to ongoing Quality Improvement. The unified system shall collect data once and use it many times without undue b urden of repeated requests to all users. This data includes medical, mental hea lth and dental information. Key performance metrics for both clinical delivery a nd business processes will be functioning in order to produce management-oriente d and individual-needs dashboards. The linkage of relevant policies to procedur es shall create measurable quality assurance. When health conditions or policie s change, the connected system shall enable systemic administration of updates. The system shall take into consideration unique Peace Corps qualities such as: a current staffing model with high turnover; a wide variety of user technical ab ilities both in clinical and administrative positions; and Peace Corps' global env ironment that includes diverse telecommunication infrastructures and irregular o utages. Irregular outages include situations where internet connections are not working but power at the site is working, or where both power and internet conne ctivity are not working. These conditions are usually brief, not lasting longer than 24 hours. Peace Corps requires a system that works under all these challen ging conditions. The new system shall have an inventory control system. It shall also monitor an d report administrative practice management data. Reports may include, but are n ot limited to: costs per Volunteer; costs of conditions; medical costs by post; and similar parameters. Objectives: 1. Maintain an Electronic Health Record (EHR) that: · Captures and records all relevant health, dental and mental health information u sing a standardized format from the application process through to the end of se rvice or close of FECA claims

· Is populated with data from an electronic health information intake form that wi ll collect medical history and current medical status · Records medical, dental, and mental health information from numerous internal an d external sources which utilize various paper processes and various electronic interfaces · Includes voice recognition software in English that accommodates a wide range of international accents 2. The CDSS shall provide comprehensive, preconfigured clinical care templa tes for utilization by medical staff. The CDSS component shall: · Provide the Office of Volunteer Support with increased clinical decision-making capabilities · Cover all major anatomical systems and their diseases, including tropical diseas es · Allow standardized care throughout the lifecycle of the Volunteer · Incorporate Peace Corps medical treatment guidelines and protocols · Provide care plans that correspond to treatment guidelines and protocols 3. Provide a Pre-Service module to conduct medical clearance that: · Collects all necessary medical, dental, and mental health information from appli cants · Interfaces with the EHR and PMS as necessary for healthcare delivery and reporti ng data · Conducts the medical clearance process with a branch-logic, decision-tree questi oning form that identifies potentially disqualifying medical history early in th e process, medical history or current status that requires additional informatio n, and current status that requires treatment and subsequent stability before me dical clearance processing can continue · Receives input from the Volunteer Lifecycle Management System, such as the proce ssing deadline of an applicant who is needed for a particular program · Uses improved business processes to ensure efficient processing (See Appendix A3 .9) · Automatically provides, to eligible users, the current Peace Corps Dental Exam, Eye Exam and Physical Examination forms (Attachments 17, 18 and 19) in accordanc e with the Medical Clearance Guidelines. See Attachment 1 for Medical Clearance Guideline Samples and Index. · Automatically provides any specialist exam requests in accordance with medical c learance guidelines · Utilizes a secure applicant portal for users to access the module, and for the m odule to deliver secure messaging and status information. See Section C 5.2.4 o f this RFP. · Stores and maintains medical clearance guidelines that determine service eligibi lity · Guides the Pre-Service Nurse as necessary with administrative decision support · Delivers regular, clear, friendly communication to applicants, addressing infor mation required to continue the medical clearance process · Stores and maintains a database of in-country medical resources that identify wh ich medical conditions each country can accommodate. See Sample Accommodation L ist, Attachment 2. · Supports production of a three-part administrative decision: 1. Medically cleared for service, including a listing of where the applican t is eligible to serve 2. Medical clearance processing is deferred due to an active condition that must be treated and stabilized for a defined period of time before processing c an continue 3. The applicant is medically not qualified to serve in the Peace Corps · Re-engineers business processes to deliver applicants ontime to programs · Reduces applicant attrition by processing medical clearances more quickly and in accordance with targeted program departure dates

4. Provide a Practice Management System (PMS) that: · Accesses medical and administrative information during initial evaluation; durin g service; and any extended support required after service · Provides a performance monitoring system that documents medical staff adherence to, or variance from, treatment protocols · Provides Quality Assurance capability requiring documented, protected peer revie w activities that must be separate from the rest of the medical record · Implements industry leading Quality Improvement standards and practices to ensur e the health of, and safe healthcare delivery to, Volunteers · Coordinates office communication, scheduling, and other office administration/ma nagement functions · Records pharmaceutical, general supply, and all inventory in each distinct locat ion · Documents usage patterns such as those by user, geographic location, affiliated use such as patient diagnosis (ICD), clinical procedure (CPT), dental condition (CDT) or patient supply request · Records duration of Volunteer illness · Supports Post-Service case management for end-of-service and DOL FECA claims · Uses HHS Electronic Transaction Standards per 45 CFR ¶ 162 5. Collects, tracks, share information and generates reports on data for al l components of the VEHS. This functionality shall provide: · Key performance metrics and tools to enable standard and ad hoc reporting to sup port data-driven decisions · Enhanced communication through workflow management within the VEHS · Enhanced communication through workflow management outside of the VEHS 6. Conforms to Service Oriented Architecture (SOA) standards. SOA shall: · Enable the exchange of data between VEHS and other Peace Corps Information Syste ms through the Peace Corps ESB · Appear as one seamless system to external users · Provide the ability to add or subtract subsystems without modification to the sy stem 7. Provides an industry-leading, secure system of architecture that meets a nd can adapt to government standards and Agency requirements for information man agement and works within Peace Corps' technical environment. The system shall: · Meet data transfer requirements of Peace Corps Posts' limited bandwidth capacitie s · Scale to increases or decreases in processing volume without affecting staffing levels · Have a common look, set of data values, branding, access, and processing methods · Contain discrete modules to allow minimum interruption to the system when busine ss processes change · Provide sustainable administration not affected by the ramifications of frequent staff turnover (the Agency's 5-year rule) · Provide necessary security and privacy provisions, policies, procedures and over sight to meet federally-mandated IT security/HIPAA/HITECH/HHS regulations/Privac y Act/Peace Corps policies for both the internal and external users. See Securi ty Requirements, paragraph 5.2.5 and Health Care Requirements, paragraph 5.2.6 5.0 General Requirements The Contractor shall provide a web-based VEHS. The Contractor shall provide a s ystem and services that address the Business Functional and Business Technical R equirements specified in Appendices A and B. In summary: · The Contractor shall submit an implementation plan describing how it will meet t he requirements specified in this solicitation · The VEHS, services, and interfaces acquired under this contract shall be deploye d in phases throughout the period of performance in order to reduce risks to the Agency

· The Contractor shall describe the hosting solution both internationally and dome stically taking into consideration Peace Corps' entire technical environment. The hosting solution shall meet all requirements for all testing, pilot and producti on systems. An external hosting facility must meet all Peace Corps' physical and cyber security requirements for hosting Sensitive but Unclassified (SBU) data. See FIPS-199: Attachment 13 and Section C, 5.2.5: Security Requirements · Accommodate a separate physical environment to be used by Peace Corps staff for training and Peace Corps' own testing and Quality Assurance activities. · Additionally, the Contractor shall be required to produce monthly status reports , conduct training, conduct assessments of pilot system implementations, and pro vide Help Desk services on an ongoing and as-required basis. See Section C, 5.2 .10: Help Desk · Once the VEHS is implemented and enters production mode, the provider will be re quired to ensure that the VEHS is continuously available on a ª24/7º basis as define d and agreed to in the Service Level Agreements. See Appendix B 3.8.1 5.1 Business Functional Requirements The system must meet the objectives found in section 5.0 with further elaboratio n found in Appendix A, Business Functional Requirements. 5.2 Technical Requirements The system shall conform to the technical environment as described within this s ection and the detailed requirements as specified within Appendix B. 5.2.1 Service Oriented Architecture (SOA) Peace Corps' future IT architectural direction will embrace the use of SOA. Refer to A Practical Guide to Federal Service Oriented Architecture version 1.1 June 30, 2008 (http://www.whitehouse.gov/omb/e-gov/pgfsoa.aspx) for more details on t he definition and recommended approach in implementing a Service Oriented Archit ecture within the federal government. 5.2.2 Peace Corps Specific SOA To-Be Environment The future SOA architectural direction for Peace Corps will make use of an Enter prise Service Bus (ESB), as depicted in Table 4. An ESB will enable communicati ons and information sharing between major applications. 5.2.3 System Interfaces The Contractor's proposal must provide system interfaces that will automate data e xchanges between the VEHS of this solicitation, and other Peace Corps systems co nnected to an Enterprise Service Bus (ESB). An ESB to support SOA-based systems is currently under development. Microsoft BizTalk was chosen as the ESB platfo rm. Table 4 illustrates the major systems that will be integrated into the ESB. Those systems and additional systems are listed below: · Volunteer Electronic Health System · Existing Software related to Volunteer Lifecycle Management and Support (PCVDBMS and MEDDBMS) · Odyssey (E-Business Financials and HRMS/Payroll) · ForPost/ForHQ (Post/HQ portions of Odyssey) · Microsoft Office SharePoint Server (MOSS) · CIRS (Crime Incident Reporting System, used to report crimes against Volunteers to HQ) · VIDA (Volunteer Information Database Application, used to manage Volunteer and b asic program information at Post) · PCVRT (Peace Corps Volunteer Reporting Tool, used to manage Volunteer activities and their impact) · Legacy Peace Corps applications (Includes many of the applications built using O racle Forms and ColdFusion to support the current VDS system) Additionally, the Contractor shall define requirements for implementing appropri ate interfaces to allow data exchanges for purposes of eliminating manual proced ures and for tracking the status of new applicants, current volunteers and Retur ned Volunteers. Table 4

5.2.4 Portals Portals proposed by the Contractor shall integrate with Volunteer Lifecycle Mana gement System portals. All portals must support single sign-on capability. 5.2.5 Security Requirements The VEHS is a Major Application (MA) in the Peace Corps System Inventory as base d upon the Office of Management and Budget (OMB) Circular A- 130 Appendix III ht tp://www.whitehouse.gov/omb/circulars_a130_a130appendix_iii. Furthermore, based on the information to be processed, transmitted and stored by the VEHS and the impact to the Agency's mission of a loss in the availability, integrity or confide ntiality of the information, this MA has been categorized as a high impact syste m per the criteria provided in the Federal Information Processing Standards (FIP S) 199- Standards for Security Categorization of Federal Information and Informa tion Systems http://csrc.nist.gov/publications/fips/fips199/FIPS-PUB-199-final.p df and NIST 800-60, Revision 1, Guide for Mapping Types of Information and Infor mation Systems to Security Categories http://csrc.nist.gov/publications/nistpubs /800-60-rev1/SP800-60_Vol1-Rev1.pdf and http://csrc.nist.gov/publications/nistp ubs/800-60-rev1/SP800-60_Vol2-Rev1.pdf. The analysis and evaluation is include d in Attachment 13, FIPS-199. The VEHS must meet current and future requirements of all relevant Office of Man agement and Budget (OMB) Memoranda, Federal Information Processing Standards (FI PS), and National Institute of Standards and Technology Special Publications (N IST) http://csrc.nist.gov/publications/PubsSPs.html, including the requirements of OMB Memoranda, FIPS, other NIST SPs and other noted references, Recommended S ecurity Controls for Federal Information Systems under all security controls ind icated as part of the moderate-impact system baseline. This list includes but i s not limited to: OMB Memorandum M-06-16, Protection of Sensitive Information, June 2006. OMB Memorandum M-07-16, Safeguarding Against and Responding to the Breach of Per sonally Identifiable Information, May 2007. FIPS-199 Standards for Security Categorization of Federal Information and Inform ation Systems FIPS-200 Minimum Security Requirements for Federal Information and Information S ystems. NIST SP 800-18, Guide for Developing Security Plans for Federal Information Syst ems; NIST SP 800-30, Risk Management Guide for Information Technology Systems; NIST SP 800-34, Contingency Planning Guide for Information Technology Systems; NIST 800-37, rev 1, Guide for Applying the Risk Management Framework to Federal Information System; NIST SP 800-53, Recommended Security Controls for Federal Information Systems. The Contractor shall comply with the delivery dates for system applications to b e submitted for independent validation and verification to complete both prelimi nary and final authorizations to operate. Peace Corps will work in conjunction with the Contractor to meet the requirement s of preliminary and final Authorizations to Operate. It is Peace Corps respons ibility to provide resources for final approval authority in accordance with NIS T 800-37. 5.2.6 Health Care Requirements The Contractor VEHS must meet all current and future requirements for electronic health records, as required by the Health Insurance and Portability Accountabil ity Act of 1996 (HIPAA) and the Health Information Technology for Economic and C linical Health (HITECH) provisions included in the American Recovery and Reinves tment Act of 2009 (ARRA), and regulations issued thereunder, to safeguard both p ersonally identifiable information (PII) and electronic protected health informa tion (ePHI). Additionally, the Contractor must ensure that all future software or system updates and/or upgrades of the VEHS remain compliant with any future s tatutory or regulatory requirements. The VEHS shall allow Peace Corps to create electronic health records that meet a ll the current requirements of HIPAA and HITECH that are being implemented by th

e U.S. Department of Health and Human Services (DHHS) Office of the National Coo rdinator for Health Information Technology (ONC) and other DHHS offices. In par ticular, the Contractor shall ensure that all current and future relevant initia l standards, implementation specifications, and certification criteria for elect ronic health records for ambulatory health care services are included in the VEH S as set out in the DHHS interim final regulations. The Contractor must deliver a certified VEHS package based on the certifications required in the DHHS inter im final regulations, or subsequent certification standards that may be issued i n the future, and maintain certifications for the entire performance period of t his contract including any options that Peace Corps may exercise. See 75 Fed. R eg. 2014 et seq. (Jan. 13, 2010); 75 Fed. Reg. 11328 et seq. (Mar. 10, 2010). The Contractor shall ensure that the VEHS meets all current and future mandatory HIPAA privacy requirements including but not limited to authorized and restrict ed use and accessibility to records, storage and protection of records, and prop er procedures for the disposal of electronic records. The Contractor shall be responsible for meeting all current and future mandatory HIPAA and HITECH security requirements applicable to electronic health records and electronic protected health information, including authorized and restricted accessibility, and storage and protection of electronic health records. The VEHS must meet current and future requirements of all relevant Federal Infor mation Processing Standards (FIPS), and National Institute of Standards and Tech nology Special Publications (NIST) http://csrc.nist.gov/publications/PubsSPs.htm l required under HIPAA or HITECH for security of ePHI as data at rest, data in m otion, data in use and data disposed using encryption methods. This list includ es but is not limited to: · NIST SP 800-111, Guide to Storage Encryption Technologies for End User Devices · FIPS 140-2 · NIST SP 800-88, Guidelines for Media Sanitization · NIST SP 800-52, Guidelines for the Selection and Use of Transport Layer Securit y (TLS) ± Implementations OR · NIST SP 800-77 Guide to IPSec VPNs OR · NIST SP 800-113, Guide to SSL VPNs or others which are FIPS 140-2 validated. 5.2.7 Hosting Support The Peace Corps headquarters software must be externally hosted. However, hosti ng status of software at Post is undetermined and the contractor shall propose t he best solution, taking the following into account: need for high accessibilit y by medical staff; latency; bandwidth; power supply issues; and the architectur e at Posts. If Contractor proposes an international solution for installed soft ware at each Post, it must be in a turnkey configuration for installation by Pea ce Corps staff. The Contractor is required to provide a hosting solution that provides full serv ice support, including the development, testing, training, pilots, phased implem entation and production operation of the Volunteer Electronic Health System taki ng into consideration all of Peace Corps technical environment. The Contractor must provide at least one physical environment separate from production. The hos ted solution is required to meet the technical requirements as specified in Appe ndix B and meet Service Level Agreements as specified therein. 5.2.8 Training The Contractor is required to propose best practice and user documentation for t he VEHS System. Training shall be provided at the Peace Corps Washington, D.C. Headquarters site . Training and documentation shall be developed and delivered for testing, acce ptance, and for each production phase.

The following types of training are required: · Training-of-Trainers (TOT) (Peace Corps in-house staff) Training is for overall system use and navigation as well as specific sub-functi ons. TOT Training shall cover all levels of use. · Peace Corps System Administrators Training and training materials shall be provided directly to Peace Corps design ated System Administrators. · Peace Corps Technical Development Staff Training and training materials shall be provided directly to Peace Corps techni cal development and support staff for the purpose of data reporting and interfac e processing across the Enterprise Service Bus. · On-going Training Modules Interactive training modules shall be incorporated into the VEHS for individual instruction. Peace Corps will use this module for self-directed, independent lea rning. Peace Corps will provide end-user training to the medical staff. 5.2.9 Implementation Plan The Contractor shall provide a detailed implementation plan in its technical pro posal. The Implementation Plan shall take into consideration the requirement th at the on-boarding function and the delivery of health care to Volunteers cannot be interrupted. Peace Corps has identified Medical Units at four Posts to implement the pilot fo r the VEHS, with the exception of the Pre-Service module, beginning in August 20 10. Feedback from the pilot will contribute to further development of the VEHS. Peace Corps plans to implement the pilot for the new Pre-Service module beginnin g October 1, 2010. Feedback from the pilot will contribute to further developmen t of the VEHS. Peace Corps plans full production of the VEHS including the Pre-Service module, beginning January 1, 2011. Regional rollouts of the entire VEHS will coincide wi th Staff Training events to facilitate end user training: · Peace Corps Headquarters ± approximately January 15, 2011 · Europe, Mediterranean, and Asia (EMA) ± approximately January 15, 2011 · Inter-America and the Pacific (IAP) ± approximately March 15, 2011 · Africa ± approximately May 15, 2011 The Contractor shall modify the implementation plan based on discoveries made du ring the Gap Analysis phase. This shall be called the ªFinal Implementation Plan.º The Contractor shall support planning efforts that include, but are not limited to: analyzing organizational needs; defining goals; objectives and metrics; plan ning implementation to determine which components will be rolled out; identifyin g and mapping requirements to system components; scheduling and assigning resour ces for a successful implementation based on organizational requirements; and ba ckup and disaster recovery planning. The Proposed Implementation Plan shall address, at a minimum, the areas outlined below: 1. Gap Analysis The proposal shall describe the contractor's methodology and schedule for determining how mission output and business processes will be affected by the tr ansformation from current systems to COTS products. 2. Configuration It is anticipated that the VEHS shall consist of one or more best-of-bre ed commercially available products with limited custom development. The Contrac tor will identify and describe mission outputs that: · Shall be achieved without configuration

· Shall require configuration to be met 3. Data Migration The Contractor shall work in conjunction with Peace Corps in the migration of da ta from existing legacy systems to the VEHS. The Contractor shall be responsibl e for the generation of specifications and development of required load routines . Peace Corps will provide data for migration from legacy systems in the load format. 4. Testing The Contractor shall conduct testing at various stages throughout the life cycle of the VEHS System. The Contractor shall provide technical support to assist w ith error detection prior to rollout and to prepare the system for the productio n environment. 5. Product Support Technical Support shall consist of Product Support and Software updates as specified in Appendix B, Technical Requirements. The Contractor shall provide such technical support services in accordance with the Contractor's software tech nical support policies in effect at the time the services are provided. During the period of performance of this contract, the Contractor shall not materially reduce the level of service provided in its technical support policies in effect as of the effective date of the contract. The Contractor's Product Support shall include, but not be limited to, the following: · 24/7 problem diagnosis and resolution, as defined within the Service Level Agree ments will provide technical users with information and assistance; · Near real-time solutions through 24/7 web and telephone access to technical expe rtise as defined within the Service Level Agreements; · Rich, web-based technical resources, including technical repositories; rapid inf ormation access; and the ability to log and track service; · Contractor Support Services for VEHS development for all system releases and pat ches; · Solutions based on current industry standards and best practices to ensure consi stent, accurate support suitable for world-wide application; · High-quality problem analysis and responsiveness on submitted service requests t hrough Service Level Agreements (SLA); and · Prioritization of service requests based on problem severity 6. Software Upgrades Contractor software assistance and problem resolution shall include, but not be limited to, the following: · Program updates and upgrades, including general maintenance releases and selecte d functionality releases · Documentation updates · Bug information and patches as they are made available · ªUpgradeº means a subsequent release of the program that the Contractor generally ma kes available for program licenses to its supported customers, provided that Pea ce Corps has ordered software upgrades for such program licenses for the relevan t time period. Upgrade does not include any release, option, or future program that the Contractor licenses separately The Contractor shall notify the COTR of any new upgrades to enhance the system. The Peace Corps reserves the right to accept or decline proposed software upgra des. There shall be no additional cost for upgrades and enhancements that are pa rt of the core product or for technical support to implement such upgrades or en hancements. 5.2.10 Help Desk Support The Contractor shall provide Help Desk technical support as tier-2 through the P eace Corps Help Desk. The Peace Corps Help Desk will provide all direct user sup port (including, but not limited to, hardware, software, and network) to the use rs as the tier-1 Help Desk. The Contractor will only be contacted by the Peace Corps Help Desk to resolve issues relating to the VEHS System application itself . No users will directly contact the Contractor and the Contractor will not hav

e to address any issues relating to user access to Peace Corps systems. The cos t for this service shall be included in the proposal. The Contractor shall provide support on a 24/7 basis as mutually agreed in Servi ce Level Agreements. For description of the requirement, please see Appendix B 3.8.1. The Contractor shall provide status reports based on the agreed upon Ser vice Lelel Agreements.

INDEX A Ablation........................................................................ ................................ CARD-2.9 Abscess, Anorectal.............................................................. ......................... GI-15 Achalasia....................................................................... ............................... GI-1 Acne............................................................................ .................................. DERM-1 Acromegaly...................................................................... ............................. ENDO-7 Actinic Keratosis............................................................... ............................ DERM-2 Adenoidectomy................................................................... ........................ .ENT-18 Adenomas........................................................................ ............................ GI-17 Addison's disease................................................................. ....................... ENDO-6 Adjustment Disorder............................................................. ........................ MH-1.1 Alopecia........................................................................ ................................ DERM-7 Alcohol Related Disorders....................................................... ..................... MH-7.1 Allergy, Drug................................................................... .............................. ALL-1 Allergy, Food................................................................... .............................. ALL-2 Allergy, Insect Sting .......................................................... ........................... ALL-3 Allergy, Other.................................................................. .............................. ALL-4 Amblyopia....................................................................... .............................. OPHTH-1 Amyotrophic Lateral Sclerosis................................................... ................... NEURO-1 Amenorrhea...................................................................... ............................ GYN-3.2 Anal Fissures................................................................... ............................. GI-15 Anaphylaxis..................................................................... .............................. ALL-5 Anemia: Auto-immune hemolytic................................................... ............... HEME-1 Anemia: B-12 Deficiency¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼.. HEME-3

Anemia: Folate Deficiency¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ HEME-3 Anemia: Megaloblastic¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼.. HEME-3 Anemia: Pernicious¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ HEME-3 Angina Pectoris¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼... CARD-8.1 Angioedema...................................................................... ............................ ALL-5 Ankylosis Spondylitis........................................................... .......................... RHEUM-3 Anorexia Nervosa................................................................ ......................... .MH-4.1 Anterior Cruciate Ligament (ACL), Injury and Repair............................. ...... ORTHO-11 Anxiety Disorder, Generalized................................................... .................... MH-2.1 Anxiety Disorder, Other......................................................... ....................... MH-2.6 Aortic Aneurysm................................................................. ........................... CARD-1.1 Aortic Coarctation.............................................................. ............................ CARD-1.2 Aortic Regurgitation............................................................ ........................... CARD-1.3 Aortic Stenosis................................................................. .............................. CARD-1.4 Appendectomy.................................................................... .......................... GI-14 Arrhythmias: Ventricular........................................................ ........................ CARD-2.7 Arthritis: Juvenile Rheumatoid, Rheumatoid...................................... ........... RHEUM-4 Arthritis: General.............................................................. ............................. RHEUM-7 Ascites......................................................................... ................................. GI-18 Asthma.......................................................................... ................................ RESP-1 Atrial Arrhythmias, Benign...................................................... ...................... CARD-2.1 Atrial Fibrillation............................................................. ............................... CARD-2.2 Atrial Tachycardia, Other....................................................... ..................... CARD- 2.3 Atrial Septal Defect (ASD)...................................................... ...................... CARD-5.1 Attention-Deficit/Hyperactivity Disorder........................................ ................ MH-3.1 Atrioventricular Blocks......................................................... ......................... CARD-4.1 Revised 2/2009 INDEX B Back Pain....................................................................... ............................... ORTHO-15 Back Sprain..................................................................... .............................. ORTHO-15 Back Strain..................................................................... ............................... ORTHO-15 Balanitis....................................................................... .................................. ID-5 Balanoposthitis................................................................. ............................. ID-5

Bariatric Surgery............................................................... ............................. GI-24 Barrett's Esophagus............................................................... ....................... GI-1 Bartholin Gland Infections...................................................... ....................... GYN-7.1 Basal Cell Carcinoma............................................................ ........................ DERM-3 Bell's palsy...................................................................... ............................... NEURO-2 Benign Paroxysmal Positional Vertigo (BPPV)..................................... ......... ENT-9 Benign Prostatic Hypertrophy (BPH).............................................. ............... GU-4 Bipolar Disorder................................................................ ............................. MH-5.1 Blepharitis..................................................................... ................................. OPHTH-2 Breast: Implants, Reconstructive Surgery........................................ ............. GYN-1.3 Breast Mass, Solid.............................................................. .......................... GYN-1.5 Bone Marrow Transplant.......................................................... ..................... HEME-6 Bowel Anastomosis............................................................... ........................ GI-14 Bowel Obstruction............................................................... .......................... GI-7 Bradycardia, Sinus.............................................................. .......................... CARD-2.6 Bronchiectasis.................................................................. ............................. RESP-2 Bronchitis...................................................................... ................................. RESP-2 Bruxism......................................................................... ................................. DENT-2.1 Bulimia Nervosa................................................................. ........................... MH-4.2 Bundle Branch Blocks............................................................ ....................... CARD-4.2 Bunions/Bunionectomy............................................................ ..................... ORTHO-4 Bursitis........................................................................ ................................. ORTHO-1 C Carcinoma, Bladder.............................................................. ........................ GU-17 Carcinoma, Bone¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ ORTHO-19 Carcinoma, Breast¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼.. GYN-1.1 Carcinoma, Bronchus............................................................. ....................... RESP-6 Carcinoma, Colorectal........................................................... ........................ GI-28 Carcinoma, Ear.................................................................. ............................ ENT-4 Carcinoma, Endometrial.......................................................... ...................... GYN-6.2 Carcinoma, Kidney............................................................... ......................... GU-9 Carcinoma, Lung.................................................................

.......................... RESP-6 Carcinoma, Neurologic........................................................... ....................... NEURO-4 Carcinoma, Ovary................................................................ ......................... GYN-4.1 Carcinoma, Prostrate............................................................ ......................... GU-6 Carcinoma, Testicle............................................................. .......................... GU-1 Carcinoma, Squamous Cell¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼... DERM-4 Carcinoma, Thyroid¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼. ENDO-8 Carcinoma, Uterine¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼.. GYN-6.5 Carcinoma, Vagina, Vulva........................................................ ...................... GYN-7.2 Cardiac Disorders, other........................................................ ........................ CARD-14.7 Cardiomyopathy.................................................................. ........................... CARD-14.1 Carotid Artery Occlusive Disease................................................ ................... CARD-10.3 Carpal Tunnel Syndrome.......................................................... ..................... ORTHO-5 Cataract: Repair, Implant¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼... OPHTH-3 Celiac Sprue¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼. GI-27 Cerebral Palsy.................................................................. ............................. NEURO-13 Revised 2/2009 INDEX Cerumen Impaction............................................................... ......................... ENT-1 Chancroid....................................................................... ................................ ID-6 Chlamydia....................................................................... ............................... ID-7 Chalazion....................................................................... ................................ OPHTH-4 Cholangitis..................................................................... ................................ GI-20 Cholecystitis................................................................... ................................ GI-20 Cholelithiasis.................................................................. ................................ GI-20 Cholescystectomy................................................................ .......................... GI-20 Cholesteatoma................................................................... ............................ ENT-2 Chronic Fatigue Syndrome........................................................ .................... ID-4 Cirrhosis....................................................................... ................................. GI-18 Coccidiodomycosis............................................................... ......................... ID-2 Colon Resection¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼.. GI-14 Colostomy¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ GI-14 Complete Blood Count¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ HEME-12 Condyloma Accuminata............................................................ ...................... ID-8 Congestive Heart Failure........................................................ ........................ CARD-3.1 Conjunctivitis¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼. OPHTH-2 Contraception¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ GYN-8.1

COPD¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼. RESP-2 Coronary Artery Angioplasty and Stents, post¼¼¼¼¼¼¼¼¼¼¼¼¼. CARD-8.5 Coronary Artery Bypass Graft Surgery (CABG)¼¼¼¼¼¼¼¼¼¼¼¼.. CARD-8.3 Coronary Artery Disease¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼. CARD-8.2 Corneal Abrasions¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ OPHTH-5 Corneal Transplants¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼. OPHTH-5 Corneal Ulcers¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼.. OPHTH-5 Counseling: Short term academia, Family, Support Group¼¼¼¼¼¼¼¼ MH-10.1 Crohn's Disease (Ileitis)¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼... GI-9 CVA¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼. NEURO-12 Cyclothymic Disorder............................................................ .......................... MH-5.2 Cysts, Breast................................................................... ............................... GYN-1.2 Cysts, Ovary.................................................................... ............................... GYN-4.2 Cystic Diseases................................................................. ............................. GU-10 Cystitis: Acute, Chronic, Interstitial.......................................... ....................... GU-18 Cystocele....................................................................... ................................. GU-22 Cystoplasty..................................................................... ................................ GU-19 D Degenerative Disk Disease....................................................... .................... ORTHO-16 Dental Problems: Congenital, Developmental...................................... ......... DENT- 1.1 Dental Decay.................................................................... ............................. DENT- 3.2 Dental Procedures............................................................... .......................... DENT- 6.1 Dentures........................................................................ ................................ DENT- 5.1 Depression: Major............................................................... .......................... MH-5.4 Dermatitis...................................................................... ................................ DERM-10 Dermatomysitis.................................................................. ........................... RHEUM-1 Deviated Nasal Septum........................................................... ...................... ENT-10 Diabetes Insipidus.............................................................. ............................ ENDO-1 Diabetes Mellitus (insulin pump)................................................ .................... ENDO-3 Diethylstilbestrol Exposure..................................................... ........................ GYN-2.1 Dislocation, Shoulder........................................................... .......................... ORTHO-13 Dissociative Disorders.......................................................... .......................... MH-9.1 Diverticulitis.................................................................. .................................. GI-10 Diverticulosis.................................................................. ................................ GI-10 Dysfunctional Uterine Bleeding.................................................. .................... GYN-6.1 Revised 2/2009 INDEX

Dysmenorrhea.................................................................... ............................ GYN-3.3 Dysphoric Disorder, Premenstrual................................................ ................. MH-5.5 Dysthymic Disorder.............................................................. .......................... MH-5.3 E Eating Disorder, not otherwise specified........................................ ............... MH 4.3 Elliptocytosis.................................................................. ................................ HEME-1 Emphysema....................................................................... ............................ RESP-3 Endometriosis................................................................... ............................. GYN-6.4 Epididymitis.................................................................... ............................... GU-2 Epididymectomy.................................................................. .......................... GU-3 Erythroplasia................................................................... ............................... ENT-15 Enucleation..................................................................... ............................... OPHTH-6 Endocarditis.................................................................... ............................... CARD-14.2 Endometrial Hyperplasia......................................................... ...................... GYN-6.3 Esophageal Obstruction.......................................................... ...................... GI-1 Esophageal Stricture............................................................ ......................... GI-1 Esophageal Tear................................................................. .......................... GI-2 Esophageal Varicies............................................................. ......................... GI-18 Esophagitis..................................................................... ............................... GI-3 Ethmoidectomy................................................................... ........................... ENT-13 F Factitious Disorders............................................................ ........................... MH-9.2 Fibrocystic Breast Changes...................................................... ..................... GYN-1.4 Fibromyalgia.................................................................... .............................. RHEUM-6 Fibrous Dysplasia............................................................... ........................... ORTHO-20 Fistulas........................................................................ .................................. GI-15 Flashers........................................................................ ................................. OPHTH-7 Floaters........................................................................ .................................. OPHTH-7 Fracture, Nose.................................................................. ............................. ENT-11 Fractures....................................................................... ................................ ORTHO-2 Fungal Infections............................................................... ............................. ID-2

G G6PD............................................................................ .................................. HEME-11 Ganglion........................................................................ ................................. ORTHO-6 Gastrectomy..................................................................... .............................. GI-5 Gastritis....................................................................... ................................... GI-4 Gastroesophageal Reflux Disease (GERD).......................................... ......... GI-3 Genital Herpes.................................................................. ............................. ID-9 Glaucoma........................................................................ .............................. OPHTH-8 Glomerulonephritis: Acute, Chronic.............................................. ................. GU-11 Gout............................................................................ ................................... ENDO-4 Gonorrhea....................................................................... .............................. ID-10 Gynecology Disorders, Other..................................................... ................... GYN-8.5 Gynecology, Surgery............................................................. ........................ GYN-8.4 H Hashimoto's Disease............................................................... ....................... ENDO-11 Headache........................................................................ ............................... NEURO-3 Hearing Impairment.............................................................. .......................... ENT-3 Hemochromotatosis............................................................... ........................ HEME-10 Hemoglobin C: Disease, Trait.................................................... .................... HEME-4 Revised 2/2009 INDEX Hemorrhoids: Internal, External................................................. .................... GI-16 Hemorrhoidectomy................................................................ ......................... GI-16 Hepatic Cysts (benign).......................................................... ......................... GI-17 Hepatitis....................................................................... ................................... GI-19 Hernia: Hiatial, Repair......................................................... ............................ GI-22 Hernia: Inguinal, Umbilical..................................................... ......................... GI-23 Herpes Simplex Keratitis........................................................ ........................ OPHTH-9 Herpes Zoster................................................................... .............................. DERM-16 Histoplasmosis.................................................................. ............................. ID-2 Hodgkin Disease................................................................. ........................... HEME-7 Horseshoe Kidney................................................................ ......................... GU-9 Hordeolum.......................................................................

.............................. OPHTH-4 Human Immunodeficiency Virus (HIV).............................................. ............. ID-3 Hydrocele....................................................................... ................................ GU-3 Hydrocephalus................................................................... ............................ NEURO-10 Hydronephrosis.................................................................. ............................ GU-13 Hydroureter..................................................................... ............................... GU-13 Hypercholesterolemia............................................................ ........................ CARD-6.1 Hyperglycemia................................................................... ............................. ENDO-2 Hypertension.................................................................... .............................. CARD-7.1 Hyperthermia, malignant......................................................... ....................... CARD-14.3 Hyperthyroidism................................................................. ............................. ENDO-9 Hypertriglyceridemia............................................................ ........................... CARD-6.2 Hypoglycemia.................................................................... .............................. ENDO-5 Hypotension..................................................................... ............................... CARD-15.1 Hypothyroidism.................................................................. ............................. ENDO-10 I Ileostomy....................................................................... ................................. GI-14 Immune Thrombocytopenia Purpura (ITP)........................................... .......... HEME-5 Impacted Third Molars (Wisdom Teeth)............................................ ............. DENT-3.4 Impaired Vision................................................................. .............................. OPHTH-1 Impetigo........................................................................ .................................. DERM-14 Impingement Syndrome and Repair................................................. .............. ORTHO-14 Impulse Control Disorder........................................................ ........................ MH-9.3 Insulinomas..................................................................... ............................... ENDO-5 Intraocular Hypertension........................................................ ........................ OPHTH-8 Intussusception................................................................. ............................. GI-7 Irritable Bowel Syndrome (IBS).................................................. .................... GI-11 Iritis/Iridocyclitis............................................................ .................................. OPHTH-13 Iron Deficiency................................................................. .............................. HEME-2 J Joint Replacement, Prosthesis................................................... ................... ORTHO-7 K

Keratinous (Sebaceous) Cyst..................................................... ................... DERM-12 Keratitis....................................................................... ................................... OPHTH-5 Kyphosis........................................................................ ................................ ORTHO-17 L Labyrinthitis................................................................... ................................. ENT-9 Lactose Intolerance............................................................. ........................... GI-12 Revised 2/2009 INDEX Lattice Degeneration............................................................ .......................... OPHTH-12 Leukemia........................................................................ ................................ HEME-6 Leukemia, Acute Lymphoblastic (ALL)............................................. .............. HEME-6 Leukemia, Acute Myelogenous (AML)............................................... ............ HEME-6 Leukemia, Chronic Lymphocytic (CLL)............................................. .............. HEME-6 Leukemia, Chronic Myelocytic (CML).............................................. ............... HEME-6 Leukemia, Hairy Cell............................................................ ........................... HEME-6 Leukoplakia..................................................................... ................................ ENT-15 Lipoma.......................................................................... .................................. DERM-12 Lobectomy....................................................................... ............................... RESP-6 Lyme disease.................................................................... ............................. ID-3 M Macular Degeneration............................................................ ....................... OPHTH-12 Mallory-Weiss Syndrome.......................................................... .................... GI-2 Marfan's Syndrome................................................................. ...................... CARD-14.4 Mammography..................................................................... .......................... GYN-8.3 Mastoiditis..................................................................... ................................. ENT-5 Mastoidectomy................................................................... ............................ ENT-5 Melanoma........................................................................ .............................. DERM-5 Meniere Disease................................................................. ........................... ENT-6 Meniscus Tears.................................................................. ........................... ORTHO-12 Menstrual Disorders: Abnormal bleeding.......................................... ............. GYN-3.1 Mitral Valve Prolapse........................................................... .......................... CARD-9.1 Mitral Valve Regurgitation...................................................... ........................ CARD-9.2 Mitral Valve Stenosis...........................................................

........................... CARD-9.3 Molluscum Contagiosum........................................................... ..................... DERM-18 Mononucleosis................................................................... ............................ ID-4 Mood Disorders, Other........................................................... ........................ MH-5.7 Multiple Myeloma................................................................ ........................... HEME-7 Multiple Sclerosis.............................................................. ............................. NEURO-1 Murmurs, Heart¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼ CARD-2.4 Muscular Dystrophy.............................................................. ......................... NEURO-5 Myasthenia Gravis............................................................... .......................... NEURO-1 Myelodysplastic Syndromes¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼.. HEME-6 Myeloid Metaplasia (Agnogenic).................................................. .................. HEME-8 Myelofibrosis................................................................... ............................... HEME-8 Myocardial Infarction, post..................................................... ........................ CARD-8.4 Myopathies¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼... NEURO-6 Myringotomy..................................................................... ............................. ENT-7 N Narcolepsy...................................................................... ............................... NEURO-7 Neck Pain....................................................................... ................................ ORTHO-15 Nephrectomy..................................................................... ............................. GU-9 Nephrolithiasis (kidney stones)................................................. ..................... GU-14 Nephrotic Syndrome.............................................................. ........................ GU-15 Nephritis....................................................................... .................................. GU-12 Nevi: Benign, Dysplastic........................................................ ........................ DERM-6 Non-Hodgkin Lymphomas........................................................... .................. HEME-7 O Obesity, Overweight............................................................. ......................... CARD-14.5 Revised 2/2009 INDEX Obsessive-Compulsive Disorder................................................... ................ MH-2.2 Onychomycosis................................................................... .......................... DERM-15 Optic Neuritis.................................................................. ............................... OPHTH-10 Orchipexy....................................................................... ............................... GU-7 Orchiectomy..................................................................... ............................. GU-1, 7 Orthodontic Treatment........................................................... ....................... DENT-4.1 Osgood-Schlatter Disease........................................................

.................... ORTHO-9 Osteoarthritis.................................................................. ............................... ORTHO-8 Osteoporosis.................................................................... ............................. ORTHO-21 Otitis, Acute................................................................... ................................ ENT-7 Otitis, Chronic................................................................. ............................... ENT-7 Otitis, Serous.................................................................. ............................... ENT-7 P Paget's disease................................................................... .......................... ORTHO-22 Palpitations.................................................................... ................................. CARD-2.5 Pancreatitis: Acute, Chronic.................................................... ....................... GI-21 Panic Disorder.................................................................. .............................. MH 2.3 Pap smear: Abnormal............................................................. ....................... GYN-2.2 Papilledema..................................................................... .............................. OPHTH-10 Parkinson's disease............................................................... ....................... NEURO-1 Patent Ductus Arteriosis (PDA).................. ................................................... CARD-5.2 Pelvic Inflammatory Disease (PID)............................................... ................. GYN-5.1 Peptic Ulcer Disease............................................................ .......................... GI-5 Peridontal Disease (Gingivitis)................................................. ..................... DENT-3.5 Perioral Dermatitis............................................................. ............................ DERM-8 Peripheral Vascular Disease (PVD)............................................... ............... CARD-10.1 Perforated Tympanic Membrane.................................................... ............... ENT-7 Personality Disorders........................................................... ......................... MH-6.1 Phobias......................................................................... ................................ MH-2.4 Pilonidal Cyst.................................................................. ............................... DERM-9 Pituitary Adenomas.............................................................. ......................... ENDO-7 Pneumonectomy................................................................... ......................... RESP-6 Pneumonia (recurrent)........................................................... ........................ RESP-2 Pneumothorax: Spontaneous, Traumatic............................................ .......... RESP-4 Polio, Post Syndrome............................................................ ........................ NEURO-8 Polycythemia Vera............................................................... ......................... HEME-8 Polycystic Ovarian Syndrome (Stein-Leventhal Syndrome)......................... GYN-4.3 Polyps, Colonic.................................................................

............................ GI-13 Polyps, Nasal................................................................... ............................. ENT-12 Polymyositis.................................................................... .............................. RHEUM-1 Polypectomy, Nasal.............................................................. ........................ ENT-12 Polypectomy, Colon.............................................................. ........................ GI-13 Posttraumatic Stress Disorder (PTSD)............................................ ............. MH- 2.5 Pregnancy, Termination.......................................................... ...................... GYN-8.2 Premenstrual Syndrome........................................................... .................... GYN-3.4 Proctitis....................................................................... .................................. GI-8 Proctocolectomy................................................................. .......................... GI-14 Prostatectomy................................................................... ............................ GU-4, 6 Prostatitis: Acute, Chronic..................................................... ........................ GU-5 Psoriasis....................................................................... ................................. DERM-11 Psychiatric V Codes............................................................. ......................... MH-11.1 Psychotic Disorder, Brief....................................................... ........................ MH-8.1 Pterygium....................................................................... ............................... OPHTH-11 Pulmonary Embolism.............................................................. ...................... CARD-13.2 Revised 2/2009 INDEX Pulmonary Valve Regurgitation................................................... .................. CARD-11.1 Pulmonary Valve Stenosis........................................................ .................... CARD-11.2 Pyelonephritis: Acute, Chronic.................................................. .................... GU-16 Pyloric Stenosis................................................................ ............................. GI-6 R Raynaud's Disease................................................................. ...................... CARD-10.2 Reactive Airway Disease......................................................... ...................... RESP-1 Reactive Arthritis.............................................................. ............................. RHEUM-2 Renal Failure: Acute, Chronic................................................... .................... GU-12 Reiter's Syndrome................................................................. ....................... RHEUM-2 Respiratory Surgery............................................................. ......................... RESP-6 Retinal Detachment/Repair....................................................... ................... OPHTH-12 Retinitis Pigmentosa............................................................ ......................... OPHTH-12 Rhinitis, Allergic..............................................................

.............................. ALL-7 Rhinitis, Non Allergic.......................................................... ........................... ALL-7 Rhinoplasty..................................................................... .............................. ENT-10 Rosacea......................................................................... ............................... DERM-8 Rotator Cuff, Injury and Repair................................................. ................... ORTHO-14 S Salivary Gland Disorders........................................................ ..................... .ENT-17 Sarcoidosis..................................................................... .............................. RESP-5 Schizophrenia................................................................... ........................... MH-8.2 Scoliosis....................................................................... ................................ ORTHO-17 Seasonal Affective Disorder..................................................... .................... MH 5.6 Seborrheic Keratosis............................................................ ........................ DERM-13 Sedatives-Hypnotics¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼. MH-2.7 Seizure Disorder................................................................ ........................... NEURO-9 Septoplasty..................................................................... .............................. ENT-10 Sialolithiasis: Current, Acute.................................................. ....................... ENT-17 Sialoadenectomy................................................................. ......................... ENT-17 Sialosis........................................................................ ................................. ENT-17 Sickle Cell: Disease, Trait..................................................... ....................... HEME-4 Sinusitis, Acute................................................................ ............................. ENT-13 Sinusitis, Chronic.............................................................. ............................ ENT-13 Sleep Apnea..................................................................... ............................ RESP-7 Sinusotomy...................................................................... ............................. ENT-13 Solitary Kidney................................................................. ............................ GU-9 Somatization Disorder........................................................... ....................... MH-9.4 Spermatocele.................................................................... ........................... GU-3 Spherocytosis................................................................... ............................ HEME-1 Spleen: Cyst.................................................................... ............................. HEME-9 Splenectomy..................................................................... ............................ HEME-9 Splenomegaly.................................................................... ........................... HEME-9 Sprains......................................................................... ................................ ORTHO-3 Spondylitis.....................................................................

............................... RHEUM-2 Spondylosis..................................................................... ............................. ORTHO-18 Spondylolisthesis (subluxation)................................................. ................... ORTHO-18 Strains......................................................................... ................................. ORTHO-3 Strabismus...................................................................... ............................. OPHTH-1 Stress Incontinence............................................................. ......................... GU-22 Sty............................................................................. ................................... OPHTH-4 Stroke.......................................................................... ................................. NEURO-12 Subluxation, Patella............................................................ ........................ ORTHO-10 Revised 2/2009 INDEX Substance-Related Disorders..................................................... ................ . MH-7.2 Syphilis........................................................................ ................................ ID-11 Syncope......................................................................... .............................. CARD-14.6 Systemic Lupus Erythematosus.................................................... ............... RHEUM-5 T Teeth: Missing.................................................................. ............................. DENT 2.2 Temporal Mandibular Joint Dysfunction (TMJ)..................................... ......... DENT.2.3 Tendinitis...................................................................... ................................ ORTHO-3 Testicular Torsion.............................................................. ........................... GU-7 Thalassemia: Disease, Trait..................................................... .................... HEME-4 Thrombocythemia: Essential (Primary)............................................ ............. HEME-8 Thrombocytopenia................................................................ ........................ HEME-5 Thrombosis, deep vein (DVT)..................................................... .................. CARD-13.1 Thrombosis, superficial vein.................................................... ..................... CARD-13.3 Thrombophlebitis................................................................ .......................... CARD-13.4 Thought Disorder, Other......................................................... ...................... MH-8.3 Thyroiditis..................................................................... ................................ ENDO-11 Tinea Cruris.................................................................... .............................. DERM-15 Tinea Pedis..................................................................... .............................. DERM-15 Tinea Versicolor¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼.. DERM-15 Tinnitus........................................................................ .................................. ENT-8 Tonsillectomy................................................................... ............................. ENT-18

Tooth, Abscessed................................................................ ......................... DENT-3.1 Tooth, Fractured................................................................ ........................... DENT-3.3 Tonsillectomy: Acute, Chronic................................................... ................. . ENT-18 Tornwaldt's Cyst.................................................................. ......................... ENT-14 Tourette syndrome............................................................... ........................ NEURO-11 Tricuspid Regurgitation (insufficiency)......................................... ................ CARD-12.1 Tricuspid Stenosis.............................................................. .......................... CARD-12.2 Tuberculosis.................................................................... ............................. ID-13 TURP............................................................................ ................................ GU-4 Tympanoplasty................................................................... .......................... ENT-7 U Ulcerative Colitis.............................................................. ............................. GI-8 Underweight..................................................................... ............................ GI-26 Undescended Testicle............................................................ ...................... GU-8 Ureterolithiasis (Urethral Stones).............................................. ................... GU-14 Urethral Obstruction............................................................ ......................... GU-20 Urethral Stricture.............................................................. ............................ GU-20 Urethritis...................................................................... ................................. GU-21 Urinary Fistula................................................................. ............................. GU-22 Urticaria....................................................................... ................................. ALL-5 Uterine Leiomyomas (Fibroids)¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼... GYN-6.6 Uveitis¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼.. OPHTH-13 V Vaginitis....................................................................... ................................. D-12, GYN-7.3 Varicella....................................................................... ................................. DERM-16 Variococele..................................................................... .............................. GU-3 Ventricular Septal Defect (VSD)................................................. .................. CARD-5.1 Ventricular Shunt............................................................... ........................... NEURO-10 Vertigo......................................................................... ................................. ENT-9 Revised 2/2009 INDEX Revised 2/2009 Vestibular Neuronitis........................................................... ......................... ENT-9 Viral Warts (Nongenital)........................................................ ....................... DERM-17 Vision Repair Surgery...........................................................

....................... OPHTH-14 Vocal Cord Lesions.............................................................. ........................ ENT-16 W Wolff-Parkinson-White Syndrome.................................................. .............. CARD-2.8 ANXIETY DISORDER NOT OTHERWISE SPECIFIED (NOS) MH 2.7 Ef fective 1/2004, Last update 10/2008 Page 1 of 2 INFORMATION REQUIRED Any history All Applicants: Mental Health Treatment Summary Form Review of functional status as documented in the Mental Health Treatment Summary If Applicable Discharge summary for all psychiatric hospitalizations Additional reviews of functional status, e.g., contact Volunteer Recruitment and Selection If likely MNQ or deferral decision, review placement file prior to MH advisor If Currently Undergoing Treatment with Psychotropic Medication · Statement from prescribing physician to include the following: Diagnosis Medication history, i.e., dates, doses, response, adverse effects. CLEARANCE CRITERIA REVIEWER GUIDANCE

No history of moderate or severe anxiety symptoms for at least the past one year Effective management of mild symptoms of anxiety for at least the past one year Functioning well socially and occupationally during the past 1 year (corresponds to a GAF of 75 or above) Active phase of psychotherapy or counseling complete. Continuing counseling for normative issues only. No history of suicide attempt, gesture, or ideation with plan in last 5 years No history of distinct coexisting psychiatric disorders (Axis I and Axis II) No history of psychosis. Not currently substance-induced anxiety Not currently anxiety due to a medical condition Meets clearance criteria 1 - 9, AND Symptom free, or effective management of mild anxiety symptoms for at least the past 1 year; AND No use of psychotropic medications ever for any mental health condition RN CLEAR (No mefloquine) PCMO FOLLOW-UP (No mefloquine) Meets clearance criteria 1-9, AND On stable medication regime for one year; OR Stable with no use of psychotropic medication for one year RN CLEAR 8B Accommodation (No Mefloquine) Does not meet clearance criteria due to one or more of the following: History of moderate or severe symptoms of this condition within the past one yea r. Ineffective management of mild symptoms of this condition within the past 1 year . Some impairment of functioning, socially or occupationally, during the past 1 ye ar (corresponds to a GAF below 75)

Active phase of psychotherapy or counseling not complete. Not stable for at least the past one year on psychotropic medication. Change in medication regime within the last year. Current substance-induced anxiety or anxiety due to a medical condition MHA DEFER Deferral period consistent with clearance criteria.

EPIDEMIOLOGIC SURVEILLANCE (ESS) REPORT FORM

Country: Region:

Month: Year:

ALCOHOL-RELATED PROBLEMS: ASTHMA (NEW & EXACERBATIONS): CARDIOVASCULAR PROBLEMS: COLPOSCOPIES (IN-COUNTRY): DENGUE: DENTAL PROBLEMS: DERMATITIS (INFECTIOUS): ENVIRONMENTAL HEALTH CONCERNS: OTHER FEBRILE ILLNESS: FILARIASIS: GASTROINTESTINAL CONDITIONS Amebiasis: Giardiasis: Helminths: Salmonellosis: Shigellosis: Bacterial Diarrhea, Other or Presumed: Viral Diarrhea, Other or Presumed: Other Diarrheal Condition: HEPATITIS Hepatitis A: Hepatitis B: Hepatitis C: Hepatitis, Other or Presumed: IN-COUNTRY HOSPITALIZATIONS: INJURIES (UNINTENTIONAL) Pedestrian: Bicycle Riding (NOTE HELMET USE IN NOTES): Motorcycle Riding: Motor Vehicle (non-Motorcycle): Water-Related Injury/Event: Sports-Related (NOTE SPORT IN NOTES): Other Unintentional Injuries: (SPECIFY TYPE & NUMBER FOR EACH): INJURIES, ALCOHOL-RELATED: LEISHMANIASIS: MEDEVACS Medevac to US Home of Record: Medevac to US Washington, DC.: Medevac to South Africa: Medevac to Senegal: Medevac to Kenya: Medevac to Thailand: Medevac to Panama:

Medevac to Australia: Medevac to Other Location: (SPECIFY LOCATION): MENTAL HEALTH PROBLEMS Recurrence of Accommodated Condition: New adjustment disorder to Peace Corps: Other Mental Health Problem: NEW ACCOMMODATED CONDITIONS: PREGNANCY: HIV POST-EXPOSURE PROPHYLAXIS (PEP): MALARIA CHEMOPROPHYLAXIS (LONG-TERM ONLY; NOT FOR SHORT-TERM TRAVEL) Mefloquine (Lariam): Chloroquine (Aralen): Doxycycline (Vibramycin): Malarone (atovaquone/proguanil): Other Chemoprophylaxis: (SPECIFY AGENT USED): FALCIPARUM MALARIA (CONFIRMED) Falciparum on MEFLOQUINE: Falciparum on CHLOROQUINE: Falciparum on DOXYCYCLINE: Falciparum on MALARONE: NON-FALCIPARUM MALARIA (CONFIRMED) Non-Falciparum on MEFLOQUINE: Non-Falciparum on CHLOROQUINE: Non-Falciparum on DOXYCYCLINE: Non-Falciparum on MALARONE: PRESUMPTIVE MALARIA Presumptive on MEFLOQUINE: Presumptive on CHLOROQUINE: Presumptive on DOXYCYCLINE: Presumptive on MALARONE: SCHISTOSOMIASIS Clinical Symptoms/Visualized Ova & Parasite: Positive Antibody Test: SEXUALLY TRANSMITTED DISEASE Bacterial STD: Presumptive Bacterial STD: Viral STD (non-HIV): Other Gynecologic Infections: HIV (Western Blot Positive): TUBERCULOSIS PPD Skin Test Conversion: Active Tuberculosis: VACCINE-PREVENTABLE DISEASES : (SPECIFY TYPE AND NUMBER FOR EACH): CORRECTIONS: (SPECIFY NUMBER OF CASES, CATEGORY, AND MONTH) ADD: DELETE: NOTES AND OTHER MAJOR CONDITIONS:

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