+-------------------------+-----------------------------+-------------+
| **STANDARDS FOR BASIC   | # *                         | Check here  |
| LEVEL OF READINESS**    | *OFFICER RESPONSIBILITIES** |             |
|                         |                             |             |
|                         | Reference:                  |             |
|                         | <http://dcp.psc.gov         |             |
|                         | /PDF_docs/Man_circ_377.pdf> |             |
|                         |                             |             |
|                         | <http://dcp.psc.g           |             |
|                         | ov/PDF_docs/04-003_PPM.pdf> |             |
+-------------------------+-----------------------------+-------------+
| (1) Possess a current   | \(a\) Ensure that           | License     |
|     valid and           | information is on file with | Exp. Date   |
|     unrestricted        | the Office of Commissioned  |             |
|     professional        | Corps Operations (OCCO).    |             |
|     license,            | Fax: 240-453-6142           |             |
|     certification,      |                             |             |
|     and/or registration |                             |             |
|     appropriate for     |                             |             |
|     officer's category  |                             |             |
|     or discipline.      |                             |             |
+-------------------------+-----------------------------+-------------+
| (2) Complete AHA Basic  | (a) Record information on   | Exp. Date:  |
|     Life Support for    |     CCRF web site           |             |
|     Healthcare          |                             |             |
|     Providers or ARC    | > <http://ccrf.hhs.gov/>    |             |
|     CPR/AED for the     |                             |             |
|     Professional        | (b) Ensure that information |             |
|     Rescuer.            |     is in OPF.              |             |
|                         |                             |             |
|                         | > Fax: 301-480-1407 or      |             |
|                         |                             |             |
|                         | 301-480-1436                |             |
|                         |                             |             |
|                         | (c) Renew Every 2 Years     |             |
+-------------------------+-----------------------------+-------------+
| (3) Complete all        | Login to                    | Cross off   |
|     readiness training  | <htt                        | as          |
|     for the BASIC level | p://learn.centrelearn.com/> | completed:  |
|     of readiness.       | complete all nine of        |             |
|                         | mandatory Web-based         | 201 202 110 |
|                         | training modules (#201,     | 141 142 147 |
|                         | 202, 110, 141, 142, 147,    | 180 182 183 |
|                         | 180, 182, 183) for          |             |
|                         |                             | &           |
|                         | ### Plus                    |             |
|                         |                             | 120 140 217 |
|                         | Three elective modules from |             |
|                         | Group A (#120, 140, 217);   | OR          |
|                         |                             |             |
|                         | ### OR                      | 111 112 114 |
|                         |                             |             |
|                         | \(b\) Three elective        |             |
|                         | modules from Group B (#111, |             |
|                         | 112, 114).                  |             |
+-------------------------+-----------------------------+-------------+
| (4) Achieve currency in | Record clinical hours on    | Total       |
|     clinical role       | the CCRF web site (if       | Hours:      |
|                         | applicable) --              |             |
| > (if applicable.)      | <http://ccrf.hhs.gov/>.     | Date:       |
|                         |                             |             |
|                         | minimum number of hours =   |             |
|                         |                             |             |
|                         | 112 w/in last 12 months.    |             |
+-------------------------+-----------------------------+-------------+
| (5) Record BMI.         | Record height/weight on the | Height:     |
|                         | CCRF web site --            |             |
|                         | <http://ccrf.hhs.gov/>      | Weight:     |
+-------------------------+-----------------------------+-------------+
| (6) Have a current      | Ensure a current medical    | Date of     |
|     Physical            | exam is on file with the    | last        |
|     Examination and     | Medical Affairs Branch.     | Physical    |
|     Medical History on  | Every 5 years.              | Exam:       |
|     file.               |                             |             |
|                         | **Mail only (no faxes)**:   | Date of     |
| **[DD-2807-1](          |                             | last        |
| http://www.dior.whs.mil | OCCSS/MAB, 5600 Fishers     | Medical     |
| /FORMS/DD2807-1.pdf),** | Lane,                       | History:    |
| [**\"Disclosure         |                             |             |
| Sta                     | Room 4C-04, Rockville, MD   |             |
| tement\"**](https://dcp | 20857                       |             |
| .psc.gov/PDF_docs/A-Gen |                             |             |
| Inst_DD2807-1_2808.pdf) |                             |             |
|                         |                             |             |
| <https://               |                             |             |
| dcp.psc.gov/opffaq.asp> |                             |             |
+-------------------------+-----------------------------+-------------+
| (7) Pass Annual         | Enter APFT results in CCRF  | Date of     |
|     Physical Fitness    | website, mail PHS-7044 with | APFT:       |
|     Test (APFT),        | results to MAB.             |             |
|     <http://ccrf.hhs    | <http://dcp.psc             | Date of     |
| .gov/ccrf/physical.htm> | .gov/PDF_docs/PHS-7044.pdf> | P.C. Award: |
|                         |                             |             |
| #### OR                 | Within Past 12 Months and   |             |
|                         | Yearly:                     |             |
| > Participate in the    |                             |             |
| > President's Challenge | ### OR                      |             |
| > Annually earning a    |                             |             |
| > Minimum of a Active   | Enter President's Challenge |             |
| > Lifestyle or Bronze   | using the USPHS Group and   |             |
| > award.                | your PHS #,                 |             |
| >                       | <http://ccrf.hhs.gov/cc     |             |
| > [htt                  | rf/Readiness/PC_SignUp.htm> |             |
| p://www.presidentschall | Within Past 12 Months and   |             |
| enge.org](http://www.pr | Yearly:                     |             |
| esidentschallenge.org/) |                             |             |
+-------------------------+-----------------------------+-------------+
| (8) Identify response   | Record a response role from | Deployment  |
|     role.               | those listed on the CCRF    | Role:       |
|                         | web site --                 |             |
|                         | [http://ccrf.hhs.           |             |
|                         | gov](http://ccrf.hhs.gov/). |             |
+-------------------------+-----------------------------+-------------+

+-------------------------------------------------+--------------------+
| **STANDARDS FOR BASIC LEVEL OF READINESS**      | Check here         |
|                                                 |                    |
| # **OFFICER RESPONSIBILITIES**                  |                    |
+-------------------------------------------------+--------------------+
| (9) Immunizations:                              | All Immunizations  |
|                                                 | Complete:          |
| > Officers are required to obtain the following |                    |
| > immunizations and/or boosters:                | Yes                |
| > Measles/Mumps/Rubella (MMR), Varicella,       | \_\_\_\_\_\_\_\_   |
| > Polio, Tetanus/Diphtheria (Td), Influenza     |                    |
| > (annually), and complete the Hepatitis A and  | Documentation sent |
| > B series. Officers are also to be screened    | to MAB:            |
| > every 12 months for Tuberculosis (PPD).       |                    |
| > Submit proof of immunizations to OCCSS/MAB.   | Y                  |
| > See MC- 377, PPM 04-003 for details.          | es\_\_\_\_\_\_\_\_ |
| >                                               |                    |
| > **YOU may fax immunization information to     | Immunizations      |
| > MAB: 301-594-3299**                           | recorded on OFRD   |
| >                                               | website:           |
| > Officers MUST also record their immunizations |                    |
| > information online using the OFRD website     | Yes\_\_\_\_\_\_\_  |
| > [http://ccrf.hhs.gov](http://ccrf.hhs.gov/)   |                    |
| >                                               |                    |
| > OFRD immunization matrix:                     |                    |
| > <http://ccrf.hhs.gov/ccrf/immuniza.htm>       |                    |
| >                                               |                    |
| > <http://ccrf.hhs.gov/ccrf/immun_guide.htm>    |                    |
+-------------------------------------------------+--------------------+
| > **Hepatitis A #1** (2^nd^ immunization in     | Date:              |
| > series or Positive Titer required after 1 MAY | #1\_\_\_\_\_\_\_\_ |
| > 2005)                                         |                    |
|                                                 | Positive Titer:    |
|                                                 | \_\_\_\_\_\_       |
|                                                 | #2                 |
|                                                 | \_\_\_\_\_\_\_\_\_ |
+-------------------------------------------------+--------------------+
| > **Hepatitis B #1** (2^nd^ and 3^rd^           | Date:              |
| > immunization in series, or Positive Titer     | #1\_\_\_\_\_\_\_\_ |
| > required after 1 MAY 2005)                    |                    |
|                                                 | Positive Titer:    |
|                                                 | \_\_\_\_\_\_       |
|                                                 | #2                 |
|                                                 | \_\_\_\_\_\_\_\_\_ |
+-------------------------------------------------+--------------------+
| > **MMR #1 and #2** (Medically documented       | Date:              |
| > history of infection, positive antibody       | #1\_\_\_\_\_\_\_\_ |
| > titers confirming natural or acquired         |                    |
| > immunity are also acceptable proof of         | #2                 |
| > immunity). Accompanying medical documentation | \_\_\_\_\_\_\_\_   |
| > must be submitted to OCCSS/MAB for            |                    |
| > confirmation.                                 | Positive           |
|                                                 | Titer:\_\_\_\_\_   |
|                                                 | \_\_\_\_\_\_\_\_   |
|                                                 |                    |
|                                                 | History:           |
|                                                 | \_\_\_\_           |
|                                                 | \_\_\_\_\_\_\_\_\_ |
+-------------------------------------------------+--------------------+
| > **Polio booster** (Must be since 18^th^       | Date:              |
| > birthday)                                     | \_\_               |
|                                                 | \_\_\_\_\_\_\_\_\_ |
+-------------------------------------------------+--------------------+
| > **Tetanus/Diphtheria (Td)** (within the last  | Date:              |
| > ten years)                                    | \_\_               |
|                                                 | \_\_\_\_\_\_\_\_\_ |
+-------------------------------------------------+--------------------+
| > **Varicella** Immunization (Medically         | Immunization date: |
| > documented history of infection, positive     | \_\_\_\_\_\_\_\_\_ |
| > antibody titers confirming natural or         |                    |
| > acquired immunity are also acceptable proof   | Positive Titer:    |
| > of immunity). Accompanying medical            | \_\_\_             |
| > documentation must be submitted to OCCSS/MAB  | \_\_\_\_\_\_\_\_\_ |
| > for confirmation.                             |                    |
|                                                 | History:           |
|                                                 | \_\_\_\_\_\_\_\_   |
|                                                 | \_\_\_\_\_\_\_\_\_ |
+-------------------------------------------------+--------------------+
| > **Influenza** (within the last 12 Months and  | Date:              |
| > Yearly)                                       | \_\_               |
| >                                               | \_\_\_\_\_\_\_\_\_ |
| > The requirement to receive an influenza       |                    |
| > vaccination during this flu season has been   |                    |
| > waived by the Assistant Secretary for Health, |                    |
| > per CCPPM 05-002, until November 1, 2005.     |                    |
+-------------------------------------------------+--------------------+
| > **Tuberculosis (PPD)** (within the last 12    | Date­:              |
| > Months and Yearly)                            | \_\_\_\_           |
| >                                               | \_\_\_\_\_\_\_\_\_ |
| > Officers demonstrating a history of positive  |                    |
| > tuberculin test should forego the annual PPD  | If applicable:     |
| > requirement. However, officers must show      |                    |
| > evidence of a course of TB prophylaxis        | Positive Test:     |
| > therapy consistent with current medical       | \_\_\_\_           |
| > standards, if indicated, AND a chest x-ray    | \_\_\_\_\_\_\_\_\_ |
| > that does not demonstrate active disease.     |                    |
| > Accompanying medical documentation must be    | Negative Chest     |
| > submitted to MAB. Positive PPD and Negative   | x-ray:             |
| > chest x-ray must be recorded on the OFRD      | \_\_\_\_\_\_       |
| > website.                                      |                    |
+-------------------------------------------------+--------------------+