1.A. For Purposes of This Guidance, Deployment/Travel Is Defined As:

1.A. (1) Travel to or through the USSOUTHCOM AOR, with time in country 

(boots on ground) for a period of greater than 30 days IAW with Ref C.

1.A. (2) Travel to or through the USSOUTHCOM AOR, with time in country 

(boots on ground) for a period of 30 days or less when in support of service component

training deployments, USSOUTHCOM joint exercise program deployments,

contingency deployments, or TDY/TAD travel under austere and/or field conditions.

1.A. (3). Personnel traveling to and/or transitioning through the USSOUTHCOM

AOR for 30 days or less, who are not specifically included in paragraph 1.A(2) such as 

official travelers in TDY/TAD status conducting brief trips in non-austere, non-field 

settings should seek travel medicine advice/services from their supporting military

treatment facility (MTF) specific to their travel itinerary and tailored to their individual 

needs. Additionally, personnel must ensure they are medically screened and cleared 

for travel to USSOUTHCOM AOR IAW Applicable Service Policies, the DoD Foreign 

Clearance Guide and Ref D.

1.B. Permanent Change of Station (PCS)

1.B. (1) PCS personnel (e.g., security cooperation office personnel and 

dependents) will coordinate with their respective service component medical personnel 

and comply with the Individual Medical Readiness (IMR) Guidance in paragraph 2 and

Immunization Requirements in paragraph 3.

2. Individual Medical Readiness (IMR) 

2.A. Periodic Health Assessments (PHA)

2.A. (1) PHA and special duty exams must be current and remain current 

throughout the deployment.

2.B. Medical Screening

2.B. (1) Vision Readiness. Service Member (SM) must meet all testing 

requirements and applicable standards for fully deployable status IAW service 

policy/guidance. For deployment to JTF-B, SM will arrive with a current refraction for 

eyewear not older than one year documented in the electronic health record or a 

handwritten prescription.

2.B. (2) Hearing Readiness. SM must meet all testing requirements and 

applicable standards for fully deployable status IAW service policy/guidance.

2.B. (3) Dental Readiness. Ensure SM has a current annual dental exam. If 
annual dental exam expires 90 days before expected redeployment date, a new exam 

will be required prior to deployment. Only SM assessed as dental readiness class 1 (I) 

or 2 (II) are deployable to the USSOUTHCOM AOR. SM assessed as class3 (III) or 4

(IV) are not deployable.

2.B. (4) Deployment-Limiting Conditions (DLC).

2.B. (4)(a) Service components are responsible for medically screening 

personnel on an individual basis prior to deployment to the USSOUTHCOM AOR IAW

Ref D, and Ref E.

2.B. (4)(b) All required medical waivers to DLC will be processed IAW Ref D prior

to deployment.

2.C. Immunization Status

2.C. (1) Ensure SM is current for total force/all services, occupational, and 

USSOUTHCOM AOR location-specific vaccines as per paragraph 3 below.

2.D. Medical Readiness Laboratory Tests

2.D. (1) Blood type and Rh factor. Required IAW service guidance.

2.D. (2) Glucose 6-PhosphateDehydrogenase (G6-PD) deficiency screening.

2.D. (3) Deoxyribonucleic Acid (DNA) specimen. Required IAW DoD/service 

policy/guidance.

2.D. (4) Tuberculin Skin Test or interferon-gamma release assays (IGRA) testing

required for all personnel deploying to Joint Task Force Guantanamo (JTF-GTMO) and 

JTF-Bravo. Other locations IAW DoD/service policy/guidance.

2.D. (5) HIV screening. Required IAW DoD/service guidance.

2.D. (6) Serum Specimens (pre & post). Required IAW DoD/service guidance.

2.D. (7) Pregnancy Test. Required for all female SM IAW DoD/service guidance.

2.D. (8) Current quantitative Hepatitis B surface antibody level titer. Required 

complete series for health care workers, emergency medical technicians and

correctional facility staff for all services.

2.D. (9) COVID-19 Test. Per specific country entry policy and DoD guidance.

2.E. Women’s Readiness Pre-Deployment Screening

2.E. (1) Female SM must complete all female specific preventive health 

requirements prior to deployment (e.g.,cervical cancer screening, mammogram 

screening) and all other applicable standards for fully deployable status IAW service
policy/guidance.

2.F. Individual Medical Equipment

2.F. (1) Corrective Eyewear/Eyeglasses. SM requiring eyewear must deploy and 

travel with at least two pairs of eyeglasses.

2.F. (2) Contact Lenses. While service policy may allow it, USSOUTHCOM SG 

recommends personnel not use contact lenses in field conditions or austere 

operational environments. Contact lenses have been identified during USSOUTHCOM

deployments as an operational hazard. Personnel deploying may encounter field 

conditions that may not allow for proper contact lens hygiene, which leads to an 

increase in eye abrasions, infections, and ulcers.

2.F. (3) Protective Mask Eyeglass Inserts. Based on occupational and 

environmental health(OEH) and operational risks.

2.F. (4) Ballistic Protection Optical Inserts. Based on OEH and operational risks.

2.F. (5) Hearing aids/batteries. As required by individual. Note: assume no 

resupply will be available at deployment location.

2.F. (6) Dental Orthodontic Equipment. As issued pre-deployment and required

by individual. Note: assume no orthodontic services will be available at deployment

location.

2.F. (7) Medical Warning Tags. As required as per service policy.

2.F. (8) Automatic positive airway pressure (APAP), continuous positive airway 

pressure (CPAP) and bi-level positive airway pressure (BPAP) IAW Ref D.

3. Immunizations

3.A Immunizations required for all personnel entering the USSOUTHCOM AOR 

(do not delay deployment if immunization series has been initiated but not

completed):

3.A. (1) Hepatitis A. Documented immunity, series complete, or dose one prior to 

departure.

3.A. (2) Influenza. Current annual vaccine. All Active Duty (AD) and Reserve 

Component (RC) (including National Guard) personnel are required to receive a 

seasonal influenza vaccine or obtain an exemption (i.e., medical, or administrative), 

IAW Ref GGG. 

3.A. (2)(a) Northern Hemisphere (NH) influenza vaccination is required for all AD 

and RC (and recommended for all other beneficiaries), permanently or temporarily 

assigned in the NH influenza zone for at least 14 continuous days or more, between 1 

October and 30 March, as designated by the World Health Organization (WHO), IAW 
Appendix 5, Ref GGG. 

3.A. (2)(b) Southern Hemisphere (SH) influenza vaccination is required for all AD 

and RC (and recommended for all other beneficiaries), permanently or temporarily 

assigned for at least 14 continuous days or more, between 1 April through the 30 

September, and in the SH influenza zone as designated by the WHO IAW Appendix 5, 

Ref GGG.

3.A. (2)(c) AD and RC members traveling between the NH and SH for 14 

continuous days or more during that hemisphere’s influenza season are required to 

receive the respective hemisphere’s influenza vaccine unless the strains in both 

vaccines are identical. AD and RC members with 14 or more days asynchronous travel 

to the NH or SH influenza zones during that hemisphere’s influenza season may elect 

to obtain the vaccination for that zone when it is available.

3.A. (2)(d) The SH or NH vaccine should be administered at least 2 weeks prior 

to entry into the respective AOR if possible.

3.A. (2)(e) Short notice travel or travel of an unspecified length will be handled on 

a case-by-case basis. If SH influenza vaccination is not possible before travel begins, 

personnel should seek vaccination from the closest OCONUS medical activity upon 

arrival in the AOR.

3.A. (2)(f) Administration of the SH or NH influenza vaccine should be separated 

by at least 30 days from any previous dose of influenza vaccine.

3.A. (2)(g) It is possible for an individual to receive a maximum of three different 

influenza vaccines in a single calendar year (e.g., a person was immunized with the 

2019-2020 NH influenza vaccine in January 2020, then was administered the 2020 SH 

influenza vaccine in preparation for a temporary duty to Australia in June 2020, and 

then returned to the United States and received the 2020-2021 NH influenza vaccine in 

October 2020.).

3.A. (3) Measles/Mumps/Rubella (MMR). Required documentation of one of the 

following: born before 1957, immunity by titer, or administration of 2 lifetime doses of

MMR vaccine.

3.A. (4) Poliovirus. One adult dose.

3.A. (5) Tetanus-Diphtheria and Pertussis. Tetanus / diphtheria. Receive a onetime dose of TDAP if no previous dose recorded. ReceiveTetanus (TD) if ≥ 10 years

since last TDAP or TD booster.

3.A. (6) Hepatitis B. Documented immunity, series complete, or dose one prior to 

departure.

3.A. (7) Typhoid. Booster dose of if ≥ 2 years since vaccination with inactivated /

injectable vaccine or ≥ 5 years since receipt of live / oral vaccine.
3.A. (8) Varicella. Required documentation of one of the following: documented 

immunity with titers, proof of series completion, or one dose prior to departure.

3.A. (9) Coronavirus Disease 2019 (COVID-19). It is strongly recommended for

all, especially high-risk individuals, to be up to date with COVID-19 vaccines prior to

entering USSOUTHCOM AOR.

3.B. Location-specific/risk-based/policy-specified/occupational immunizations

3.B. (1) Pneumococcal. Required for all personnel who are in a high–risk 

category due to age or underlying health conditions as per ACIP recommendations (for

example, persons without spleens).

3.B. (2) Rabies (pre-exposure). Required for all high-risk individuals (e.g., 

veterinarians, veterinary technicians, animal handlers, security personnel who have 

animal control duties, special operations personnel and personnel who cannot receive 

prompt medical evaluation and risk-based post-exposure prophylaxis or be medically 

evacuated within 72 hours of being bitten). May be considered for other personnel at 

risk of animal contact (e.g., civil affairs personnel). For previously vaccinated

personnel, booster dose is required every two years if titers are below acceptable level.

3.B. (3) Yellow Fever (YF).

3.B. (3)(a) Required for personnel deploying, and/or TDY to JTF-B. A single lifetime dose is sufficient per ACIP recommendation.

Exception: Additional doses of Yellow Fever vaccine are recommended for:

a. Women who were pregnant (regardless of trimester) when they received their 

initial dose of yellow fever vaccine should receive 1 additional dose of Yellow Fever 

vaccine before their next travel that puts them at risk for Yellow Fever virus infection.

b. Persons who received a hematopoietic stem cell transplant after receiving a 

dose of Yellow Fever vaccine and who are sufficiently immunocompetent to be safely 

vaccinated should be revaccinated before their next travel that puts them at risk for

Yellow Fever virus infection.

c. Persons who were infected with human immunodeficiency virus when they 

received their last dose of Yellow Fever vaccine should receive a dose every 10 years 

if they continue to be at riskfor yellow fever virus infection.

d. Laboratory workers who routinely handle wild-type Yellow Fever virus should 

have Yellow Fever virus–specific neutralizing antibody titers measured at least every 

10 years to determine if they should receive additional doses of the vaccine. For

laboratory workers who are unable to have neutralizing antibody titers measured, 

Yellow Fever vaccine should be given every 10 years if they remain at risk.

e. A booster dose shall be given to travelers who received their last dose of 
Yellow Fever vaccine at least 10 years previously and who will be in a higher-risk 

setting based on season, location, activities, and duration of their travel. This would 

include travelers who plan to spend a prolonged period in endemic areas or those 

traveling to highly endemic areas such as the Amazon basin during peak transmission 

season or an area with an ongoing outbreak. Commander’s discretion is allotted to 

determine whether travelers’ deployment location meets the definition of a higher risk

setting IAW USSOUTHCOM FHP guidance section 3.B (3) Yellow Fever.

3.B. (3)(b) The vaccination is required for Yellow Fever endemic countries: 

Argentina, Bolivia, Brazil, Colombia,Ecuador, French Guiana, Guyana, Panama, 

Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela (review CDC guidance for 

updated list of endemic countries at

www.cdc.gov/yellowfever/maps/south_america.html

3.B.(3)(c) Yellow Fever vaccination required for the following countries if you are 

traveling from a country listed in 3.B.(3)(b): South America (Chile, Uruguay), Central 

America (Belize, Costa Rica, El Salvador, Guatemala, Nicaragua, Honduras) 

Caribbean islands (Antigua and Barbuda, Aruba, Bahamas, Barbados, Dominica, 

Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Monserrat,

Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines.

3.B. (3)(d) If traveling to and from a Yellow Fever endemic country listed in 

3.B.(3)(b), carry a copy ofyour SF 601, Health Record Immunization Record; CDC 731,

International Certificate of Vaccination; DD form 2766c, Adult Preventive and Chronic 

Care Flow Sheet to prevent revaccination by health authorities.

3.B. (3)(e) SM travel itinerary must be carefully reviewed and considered 

(countries visited/airports transited prior to entry). Please contact USSOUTHCOM SG 

office if further guidance is needed.

3.C. Immunization Tracking

3.C. (1) Tracking of immunizations for all SM deploying to USSOUTHCOM AOR 

will be IAW DoD- approved systems as per Ref G and service policy/methods.

3.D. Proof of Immunization Documentation

3.D. (1) When travelling to the USSOUTHCOM AOR, all DoD personnel must 

carry an updated official paper immunization record. This official record must be in any 

of the DoD-approved formats that qualify as a valid certificate of vaccination for 

international travel and that comply with world health organization’s international health 

regulations requirements. These include SF 601, Health Record Immunization Record; 

CDC 731, International Certificate of Vaccination; DD form 2766c, Adult Preventive and

Chronic Care Flow Sheet.

4. Personal Protective Equipment (PPE) and Medications
4. A. DoD insect repellent system components.

4.A. (1) All personnel deployed to the USSOUTHCOM AOR must strictly adhere 

to the concurrent use of all three components of the DoD insect repellent system which 

are: permethrin treated civilian clothes or uniforms, DEET on exposed skin, and 

properly worn uniform.

4.A. (2) Field uniforms. Personnel will deploy with at least 2 Operational 

Camouflage Pattern (OCP) uniforms (each permethrin treated OCP is good for 25

washes).

4.A. (3) Permethrin uniform treatment methods. Uniform treatment with 

permethrin must be accomplished prior to deployment. The four DoD-approved 

permethrin uniform treatment methodsare: 1) IDA kit; 2) aerosol spray can; 3) twogallon sprayer; 4) factory treatment. 

4.A. (3)(a) Individuals authorized to deploy or travel in civilian clothes will treat 

clothing worn during operations with DoD permethrin aerosol spray (NSN: 6840-01-

278-1336) IAW the label instructions. Field clothing includes civilian attire which is 

defined as all exterior clothing, and any trousers and collared shirt worn in an 

operational setting. Any fabric may be treated. However, the ability of permethrin to 

bind to clothing fabrics and be retained for 6 weeks or 6 washings may vary by fabric

type. Individuals should deploy with a minimum two sets of permethrin-treated civilian 

clothes (long sleeves and pants). Do not use any permethrin product on hats, 

headgear, underwear, PT uniforms,t-shirts, or NOMEX uniforms. Spray only the outer

surfaces.

4.A.(3)(b) Do not dry clean permethrin treated uniforms or civilian clothes as this 

will remove the permethrin.

4.A. (4) DEET skin repellant: insect/ arthropod repellent lotion, NSN: 6840-01-

284-3982. All personnel will deploy with four tubes for initial issue or any other DoDapproved DEET-based skin repellant product on the NSN list containing between 30-

35% DEET.

4.B. Other Vector Countermeasures

4.B. (1) Bed net, pop-up, self-supporting low profile bed net (SSLPB), treated 

with permethrin repellent, green camouflage, NSN: 3740-01-516-4415 or coyote 

brown, NSN: 3740-01-518-7310. If the pop-up bed nets are not readily available, obtain 

any other military or commercially available bednet. These are critical for protecting 

SMs. Bed nets are not required for personnel deploying to Guantanamo Bay, Cuba

(GTMO).

4.B. (2) Non-authorized products. Personnel must only use products authorized 

by Armed Forces Pest Management Board (AFPMB) for personal protection. 

Unauthorized products may be less effective or hazardous when used in a manner not

approved by the label or hazardous to use on humans (e.g., Flea collars).
4.C. General Health Care Individual Issued Items

4.C. (1) Sunscreen SPF-15 or greater. Especially important for personnel taking

doxycycline for malaria prophylaxis.

4.C. (2) Lip balm (NSN: 6508-01-265-0079). Especially important for personnel 

taking doxycycline for malaria prophylaxis.

4.C. (3) Double-sided combat arms earplugs (NSN: 6515-01-466-2710) or single 

or triple flange earplugs.

4.C. (4) Water purification tablet iodine (NSN: 6850-00-985-7166) or other 

service-approved individual water purification method for emergency use.

4.C. (5) Waterless hand sanitizer (NSN: 8520-01-490-7358).

4.D. Additional Recommended Items. Improved first aid kit (NSN: 545-01-530-0929).

4.E. Occupational Personal Protective Equipment (PPE)

4.E. (1) Pre-deployment mission analysis must consider occupational PPE 

requirements for providing SM with adequate protection from all types of workplace 

hazards during the conduct of operations in the deployment setting, including chemical, 

biological, mechanical, radiological, environmental noise, particulate matter, air 

pollutant, climatic, and COVID-19. The required PPE should be available in sufficient 

quantities to provide protection to everyone with potential exposure to pre-identified 

hazards. On-site commanders and personnel should also evaluate the need to update 

PPE, based on their continuing reevaluation of operational risks.

4.F. Occupational personal Monitoring Devices & Exposure Dosimeters. As per

service policy.

4.G. Prescription Medications

4.G. (1) Ensure personnel deploy with a 90-day supply of any required personal 

prescription medications. SM deploying to JTF-B must submit prescription to Tricare 

mail order Pharmacy (TMOP) and have approval for 9 months prior to deployment. 

Inability to obtain medication via theTMOP requires JTF-B medical commander

clearance prior to deployment/assignment.

4.H. Durable Medical Equipment. As per service policy

4.I. Personal Durable Medical Equipment

4.I. (1) Other than items listed in paragraph 2.F., durable medical equipment is 

not permitted in USSOUTHCOM austere deployment settings (e.g., CPAP, tens, etc.).

4.J. Deployment Health Record (DD form 2766 Adult Preventive and Chronic Care 

Flow Sheet)
4.J. (1) All deploying personnel (military and DoD civilian) will deploy with a 

deployable medical record (DD form 2766) updated with blood type, medication/ 

allergies, special duty qualifications, immunization record, pre-deployment health 

assessment form, and summary sheet of past medical problems. Units deploying to 

JTF-GTMO will deploy with dental records and tuberculosis test resultsdocumentation.

4.J. (2) All SM requiring deployment medical waivers (paragraph 2.B.(4)) will 

have a copy of the approved waiver in the deployable health record.

4.J. (3) Deployment health records will be returned to the demobilization station 

for review during medical out-processing and then returned to home station following 

mobilization/deployment processing. Upon return to home station, the DA form 2766 

will be integrated into the SM's permanent medical record.

5. Force Health Protection Prescription Products (FHPPP)

5.A. Malaria Chemoprophylaxis

5.A. (1) Malaria is a health risk in most countries in the USSOUTHCOM AOR. 

However, specific risks and chemoprophylaxis requirements vary by location and 

operational circumstances. Review the malaria country table and specific country’s 

baseline infectious disease risk assessment from the National Center for Medical 

Intelligence (NCMI) for individual Malaria risk assessments at

https://www.ncmi.detrick.army.mil/ or http://www.ncmi.dia.smil.mil; CDC travelers 

health website at http://www.cdc.gov/malaria/travelers/index.html prior to deployment.

5.A. (2) Leaders at all levels must ensure all personnel deployed in the 

USSOUTHCOM AOR strictly adhere to all malaria countermeasures (DoD insect 

repellant system, permethrin-treated bed nets),not just FHPPP.

5.A. (2)(a) In some Malaria-endemic countries in the USSOUTHCOM AOR, the 

Malaria risk may be significantly lower in capitals and major cities, particularly in 

locations where Malaria vectors are rare and human infection rates are very low. Upon 

careful preventive medicine (PM) analysis, Commanders may decide not to employ 

malaria chemoprophylaxis for/in personnel on short-durationTDY/TAD travel to such 

cities if overnight stays are in air-conditioned lodging. This same chemoprophylaxis 

decision making process may apply to transiting aircraft personnel (remain over night

or stage). 

5.A. (2)(b) Primary malaria chemoprophylaxis. Ref G provide guidelines and best 

practices in the choice of primary malaria prophylaxis medications. In chloroquineresistant malaria areas, first-line prophylactic medication choices are doxycycline and 

atovaquone-proguanil. Mefloquine should be reserved for individuals with intolerance 

or contraindications to first-line choices. Contact service component surgeon or 

USSOUTHCOM Surgeon FHP division for further guidance in chemoprophylaxisdrug

choice decisions. 
5.A. (3) Presumptive anti-relapse therapy (terminal chemoprophylaxis):

5.A. (3)(a) Generally recommended for all individuals who were put on primary 

malaria chemoprophylaxis and had prolonged exposure to relapsing forms of malaria 

(p. Vivax in USSOUTHCOM AOR). Terminal chemoprophylaxis should begin once the 

potential for diseasetransmission ends, such as departure from the risk area or AOR.

5.A. (3)(b) Confirm all deployed personnel have a G6PD test. G6PD deficient 

individuals must not begiven primaquine due to the risk of hemolytic anemia.

5.A. (4) In areas where malaria is endemic and deployed medical support can 

diagnose malaria, they should carry malaria treatment medications.

6. Preliminary Hazard Assessment

6.A. General

6.A. (1) Units deploying to the USSOUTHCOM AOR must conduct a preliminary 

hazard assessment as a first step in the pre-deployment health risk assessment.

6.A. (2) Unit and/or supporting Preventive Medicine (PM) personnel should 

consult NCMI, USAPHC, NMCPHC, USAFSAM,CDC, AFPMB, Pan-American Health 

Organization (PAHO), host nation MOH and other sources of endemic disease 

information for the area of operations (AO). In addition, units should review past hazard 

assessments, recent exercise, or operation AAR, and/or other available data to identify

potential OEH/endemic disease (ED) threats and hazards to deploying personnel.

6.A. (3) The PHA is a key action in establishing PM requirements, allocating and 

assigning appropriate medical resources to conduct pre-deployment OEH/ED site 

assessments, establishingOEH/ED baseline conditions, employing effective pm 

countermeasures, developing health risk communication strategies, and planning for

deployment health/medical surveillance.

6.A. (4) Based on mission planning; commanders will be responsible for tasking 

their unit intelligence personnel to gather finished OEH/ED threat assessments 

produced by the NCMI. Depending on the mission type or criticality of information for 

mission assurance, production of such assessments when non-existent or out-of-date 

should be requested. Tasking for collection or requesting collectionof information will

also be a unit commander’s responsibility.

6.A. (5) The following are hazards of importance in the USSOUTHCOM AOR. As 

such they should be analyzed before any deployment to the AOR.

6.B. Foodborne and Waterborne

6.B. (1) Acute diarrheal diseases
6.B. (1)(a) Bacterial and protozoal diarrhea, Hepatitis A, Typhoid/Paratyphoid 

fever, Brucellosis, Cholera, and Hepatitis E constitute the greatest potential infectious 

disease threat to DoD members during deployments where local food, water or ice are 

consumed. To counter this threat, no food or water (including ice) should be consumed 

unless an appropriate risk assessment is performed by U.S. Military medical authorities

and is reviewed/approved by the unit commander. Field sanitation and hygiene will be

continually emphasized, and requirements followed.

6.B. (1)(b) Recent Cholera outbreaks have been confirmed on Caribbean islands 

and is expected to spread to other countries in the region. Because cholera is an acute 

diarrheal disease that can kill within hours if left untreated, personnel with sudden 

onset of profuse, watery stools should report to medical authorities immediately. If

going to a cholera-present or areas of low public health infrastructure, units are 

recommended to deploy with stocks of oral rehydration salts (NSN: 6S05-01-197-8809) 

and appropriate antibiotics if self-supported by medical personnel and reliable access

to a safe water source.

6.C. Vector-Borne Diseases

6.C. (1) Vector-borne diseases are transmitted in the AOR by mosquitoes, 

sandflies, ticks, triatomines, lice, and fleas. Vector-borne diseases can significantly 

impact force health unless preventive measures are enforced. Avoidance of vectors 

(24 - hrs./day) is key and can be accomplished through habitat awareness and use of

preventive measures.

6.C. (2) Chikungunya/ Dengue Fever/Zika risk are widespread across the AOR 

with outbreaks routinely reported in most countries in the region. The mosquitoes that 

transmit Chikungunya/Dengue/Zika are known to bite during the day. Personal 

protective measures are required 24hrs a day throughout the AOR and must be given 

the highest priority (see para 5.A. Forminimal personal issue PPE). Another method of 

prevention is the regular elimination of standing pools of water in the area since these

habitats serve as mosquito breeding grounds.

6.C. (3) Malaria risk is regional with outbreaks occurring frequently in endemic 

areas. Malaria- carrying mosquitoes bite from dusk to dawn. Symptoms typically

develop one to two weeks after the initial bite of an infected mosquito. However, 

symptoms can also present as late as several months or more following departure from 

the malaria-endemic region. Personnel who are currently or have been recently 

deployed in high-risk areas must be briefed on the importance of seeking medical

evaluation as soon as possible in the event fever is experienced while in the area or 

upon return. At risk SM should employ protection measures against mosquitoes (see 

para 4.A.) In conjunction with the proper use of malaria chemoprophylaxis (see para 

5.A.).

6.C. (4) Leishmaniasis occurs in three forms: cutaneous, mucosal, and visceral. 

All forms are transmitted by sandflies, and the risk of being bitten is greatest from dusk 

to dawn and in rural areas. Cutaneous Leishmaniasis (CL) is the most common form of

the disease. Most CL cases occur in Bolivia, Brazil, Colombia, and Peru. Although CL

primarily affects the skin, the parasite that causes the characteristic skin lesions can 
also spread to the mucosal surfaces of the nose and mouth. Visceral Leishmaniasis’s 

(VL) is found primarily in Brazil, and to a lesser extent in other parts of central and 

South America. Personnel deployed to areas of higher risk should avoid sandfly bites

using the DoD insect repellent system. No vaccine exists for any form of the disease.

6.C. (5) American trypanosomiasis (also known as Chagas disease) is endemic 

in Central and South America. Chagas disease is transmitted through the feces of 

Triatomine insects (such as the Kissing Bug), which can be introduced to the 

skin/mucosa of the eyes, nose, or mouth when an insect bite is rubbed or through the 

consumption of contaminated food and beverages. Symptoms of acute infection 

usually develop approximately one week after exposure, and last up to 90 days. This 

stage is treatable but then is followed by an untreatable chronic stage which has the 

potential to cause permanent damage to your heart and intestinal tract. No vaccine 

exists, and personnel should avoid infection through use of protective measures and

compliance with food and water consumption guidelines. (See para 8.E).

6.D. Water Contact Diseases

6.D. (1) Leptospirosis. Risk is limited to personnel with freshwater contact such 

as boating, wading, immersed or swimming in bodies of water contaminated by animal 

urine. Leptospira enter the body through cut or abraded skin and mucous membranes, 

such as the eyes or nose. Direct contact with the infected bodily fluids of animals can 

also result in disease. Leptospirosis causes debilitating febrile illness, which typically 

requires one to seven days of inpatient care. Personnel should avoid contact with fresh 

surface water. Flooding can increase risk of transmission. Rescue personnel operating 

in flooded areas and evacuees may suffer cuts or abrasions that increase the risk for

infection. Persons at an increased risk for disease should minimize contact with 

potentially contaminated water and wear protective equipment including face shield or 

goggles, waterproof boots, gloves, and aprons. Cuts and abrasions should be 

appropriately covered with waterproof dressings. There is no vaccine available.

Note: Swimming in hotel or public swimming pools is not advised during official travel in 

many parts of the AO.

6.D. (2) Schistosomiasis is endemic to Brazil, Suriname, Venezuela, and some 

Caribbean islands. Infection occurs through direct contact with contaminated water. 

The acute form of the disease has an incubation period 14 to 84 days, while the 

chronic form has the potential to remain for years. Severe health complications can 

develop because of chronic infection. To prevent infection, personnel should avoid 

direct contact with bodies of freshwater in endemiccountries and wear protective

clothing and footwear if such contact is unavoidable. Personnel should also adhere to 

all water consumption guidelines (see para 7.E.). There is currently no vaccine 

available.

6.E. Sexually Transmitted Infections

6.E. (1) Sexually transmitted infections (STI) include Gonorrhea, Chlamydia, 

HIV/AIDS, Hepatitis B,and Syphilis. Abstinence is the only way to ensure prevention of 

an STI. Detection of an STI in a potential partner is often impossible. Latex condoms 
should be made available and used by all who choose to be sexually active. Synthetic, 

non-Latex condoms should be used by those who are or whose partners are latex 

allergic or sensitive. Proper use includes placement prior to sexual contact, use of 

non-petroleum lubricant to decrease condom breakage, and use of a new condom with 

each sexual contact. Personnel should seek prompt medical treatment for STI

symptoms.

6.F. Aerosolized Dust or Soil-Contact Diseases

6.F. (1) Hantaviruses. Humans may be infected with Hantaviruses by breathing 

air contaminated with the feces, urine, and/or saliva of certain species of wild rodents, 

or by direct contact with such rodents or their feces, or through their bites. The primary 

route of infection, inhalation, is almost always associated with indoor environments 

where infected rodent excreta is present. These indoor environments also limit 

dissipation of aerosolized and favor virus viability due to restricted air movement and 

lack of direct sunlight respectively.

6.F. (2) Travel to and within all areas where Hantavirus infection has been 

reported is safe. The possibility of exposure to Hantavirus in field environments is very 

small and reduced even more if steps are taken to minimize rodent contact. However, 

the disease’s high fatality rate is ample reason for concern. It is prudent to assume a 

"worst case scenario" when dealing with wild rodents or rodent-contaminated buildings. 

Personnel in the field for short periods are at minimal risk if the procedures listed below 

are followed. However, if personnel are required to use seasonal buildings or shelters, 

then an initial inspection for rodents or signs of rodent contamination should be made

before troops enter and begin to disturb dust and furnishings inside. If evidence of 

rodents (live or dead animals, droppings, urine, or nesting material) is found inside the 

building, then entry and use should be prohibited until rodent contamination is removed 

or personnel wear equipment that protects them against Hantavirus infection.

6.F. (3) The best currently available approach for disease control and prevention 

is risk reduction through environmental modification and hygiene practices that prevent 

or deter rodents from colonizing building structures. Building surveys should be 

performed on a regular basis, and any indication of rodent activity should be addressed 

immediately. Sanitation practices are essential in deterring rodents from entering 

buildings. All sources of food and water available to rodents should be eliminated. 

Please consult Ref H for safe cleanup operations and procedures for rodent waste and 

nesting materials including required PPE.

6.G. Animal Contact Diseases

6.G. (1) Animals are carriers and reservoirs for multiple diseases to include 

Rabies, Q Fever, Brucellosis, Hantavirus, and Avian/Swine Influenza. Dog, cats, bats, 

and wild carnivores represent the greatest risk to personnel deployed to the 

USSOUTHCOM AOR. Personnel must avoid contact with local animals in the 

operational setting and must not attempt to feed, adopt, or interact with them in any 

way. Personnel must not keep mascots and pets. Uncured hides present an anthrax 

risk and must be avoided.
6.G. (2) Rabies

6.G. (2)(a) Rabies is a viral infection that can be transmitted to humans through 

the saliva of infected animals. Because the disease is prevalent in the Caribbean, 

Central and South America, it constitutes a health threat to SM deployed/TDY to the

USSOUTHCOM AOR.

6.G. (2)(b) Other than U.S. military working dogs, animals must not be 

considered rabies-free when deployed. Animals infected with rabies may not look sick 

or act strangely, enabling a seemingly healthy animal to spread the disease to humans. 

Personnel must never assume local animals are vaccinated against rabies. Despite 

efforts of countries in the USSOUTHCOM AOR to institute vaccination programs for 

dogs, cases of dog-transmitted human-rabies continue to be regularly reported. Dogs, 

cats, bats, foxes, skunks, raccoons, mongooses, and jackals are among the most likely 

animals to transmit rabies. In certain rural areas or tropical forest locations, personnel 

may be at increased risk of bat bites. Bat bites may occur at night during personnel 

sleeping hours and thus may go unnoticed. In 2010 and 2011 outbreaks of battransmitted human rabies were reported in several South American countries and 

continues to be reported by local health authorities throughout theUSSOUTHCOM

AOR.

6.G. (2)(c) The time between human exposure to rabies virus and onset of 

symptoms varies but averages two to twelve weeks. In rare cases, symptoms may not 

appear for over one year. Once the signs and symptoms of rabies occur, the disease is 

almost always fatal. However, if medical evaluation and treatment is commenced 

promptly following a potential rabies exposure, nearly all cases of rabies will be

prevented.

6.G. (2)(d) Unit commanders must ensure personnel compliance with this 

guidance and all prevention and post-exposure evaluation and care actions IAW Ref I 

and Ref J. Commanders must mandate a “no mascot” policy; personnel will be 

instructed to not feed, handle, or otherwise contact local animals outside of directed 

operational missions. Commanders will mandate reporting of all animal bite wounds 

and scratches to include any broken skin contact with animal saliva. This includes 

wounds or lacerations that occur even without a known animal exposure. Some rabies 

carrying animals (i.e., vampire bats) can produce wounds when sleeping that are not 

perceived due to anesthetic properties of the animal’s saliva. All human-animal contact 

incidents must be reported immediately to ensure the safety and well-being of 

personnel. In the case of a reportable human-animal contact event, an immediate 

review of unreported injuries to unit personnel caused by animals must be conducted 

for the preceding 18-month period. All personnel with injuries caused by animals must 

be identified and evaluated by medical personnel to ensure proper treatment is 

provided. Medical personnel will document all animal bites and scratches on DD form 

2341 report of animal bite – potential rabies exposure. The DD form 2341 will be 

properly routed and completed in its entirety through final case disposition, to include 

the multi-disciplinary review of the circumstances of each potential rabies exposure by

the rabies advisory team/board.

6.H. Respiratory Diseases
6.H. (1) Tuberculosis (TB) is endemic in the USSOUTHCOM AOR. The risk may 

be elevated for those personnel with significant close contact with local populations. As 

with many regions of the world, drug resistant strains are present in the 

USSOUTHCOM AOR. To mitigate the threat, avoid prolonged contact in crowded or

enclosed areas and ensure TB testing is accomplished IAW para 2.D.(4).

6.I. Natural Physical Threats to Health

6.I. (1) Weather Hazards. Deployed personnel must take appropriate precautions 

about lightning, sun exposure, heat/humidity, exposure to rain, wind, and cold 

temperatures. Exercise caution when conducting operations in times of limited visibility. 

Follow the evacuation plan in the event of severe weather (tornados, hurricanes, or

storm surge).

6.I. (2) Heat/Cold/Solar Injuries/Illness.

6.I. (2)(a) In the USSOUTHCOM AOR, heat injuries may constitute the greatest 

environmental threat to deployed personnel. The tropics pose health risks related both 

to extreme temperatures, humidity, and sun exposure. Injuries can include dehydration,

heat exhaustion, heat stroke, and sunburn. Certain FHPPP, such as doxycycline, may 

increase susceptibility. Personnel should gain familiarity with the temperature range in 

the intended destination, noting any potential for severe fluctuations between daytime 

and nighttime temperatures. Acclimatization may take 10-14 days or more. Ensure 

proper work-rest cycles, adequate hydration. Command emphasis of heat injury 

prevention is paramount. Units will make available and enforce use of individual 

protection supplies, such as sunscreen, lip balm, covers (hats), and sun 

goggles/glasses. Ensure personnel are capable of recognizing signs related to heat

illness and responding with proper methods.

6.I. (2)(b) Risk of cold injury will depend on the specific region but can occur in 

any environment. Hypothermia, a life-threatening condition, can occur at 55 degrees 

Fahrenheit (air temperature). The risk of cold injury is increased in persons who are in

poor physical condition, dehydrated, or wet.

6.J. (3) Altitude

6.J. (3)(a) Operations at high altitude (over 8000 ft.) are at special risk; 

approximately 20 percent of personnel may be susceptible to altitude sickness at these 

altitudes. High altitudes can cause illness or death. High altitude medical threats

include acute mountain sickness, high altitude bronchitis, high altitude cerebral edema, 

and high-altitude pulmonary edema. High altitude-regions exist in the following AOR 

countries: Peru, Bolivia, Chile, Argentina, Venezuela, Ecuador, Colombia, Guatemala,

and Costa Rica. Specialty equipment and medications may be necessary for personnel 

deploying or traveling to locations at high altitude. All ascents should be performed 

gradually, if possible. Going directly from low altitude to >9,000 ft. (2,750 m) in one day 

should be avoided. Use acetazolamide (Diamox) to speed acclimatization if abrupt 

ascent is unavoidable. Treat altitude headaches with simple analgesics. High altitude 

illnesses can constitute a medical emergency and require immediate treatment and 
descent to save the SM’s life.

6.J. (3)(b) Sun exposure at high altitudes may also produce adverse health 

effects associated with the eyes (cataracts) and skin (skin cancer, sunburn) (see

https://www.cdc.gov/cancer/skin/basic_info/sun-safety.htm) Wraparound sunglasses 

that provide 100 percent UV ray protection should be worn for eye protection. A broadspectrum (protection against both UVA and UVB rays) sunscreen and lip screen with at

least SPF 15 should be used.

6.K. Dangerous Flora and Fauna

6.K. (1) Various species of poisonous animals, including reptiles and arthropods 

are present. A current list of venomous animals by country is available at 

https://www.acq.osd.mil/eie/afpmb/docs/lhd/venomous_animals_bycountry.pdf

Education/awareness and avoidance are required to prevent snakebite incidents.

6.K. (2) Displaced reptiles, such as snakes, are likely to be found following 

flooding and other natural disasters. The venom of a small or immature snake can be 

even more concentrated than that of larger ones; therefore, all snakes should be left 

alone. Medical attention should be immediately sought any time a bite wound breaks

the skin. For treatment procedures, personnel should seek medical advice/services 

from their supporting MTF. 

6.K. (3) There are numerous plants that are hazardous to human health in the 

USSOUTHCOM AOR. Plant hazards are present in the form of mechanical injury, 

contact dermatitis and poisonous when consumed. Personnel need to be briefed on

specific AO hazards. 

6.L. Industrial Hazards

6.L. (1) General. During natural or man-made disasters, industrial facilities may 

release hazardous materials (e.g., toxic industrial chemicals (TICS)/toxic industrial 

materials (TIMS)) resulting in air, soil,food, and water pollution or cause the release of

biologic contaminants.

6.L. (2) Contamination and pollution. Contamination of surface and ground water 

with raw sewage and industrial wastes, urban air pollution and food sources 

contaminated with agricultural chemicals or pesticides pose localized threats. Consult

NCMI or USAPHC for location-specific information.

6.L. (3) Other. Occupational/operational health threats must be evaluated in 

mission analyses. Preliminary hazard assessments (PLHA) should be accomplished as 

part of the OEH site assessment (OEHSA) as early as possible (preferably during predeployment site survey (PDSS)) to identify and quantify OEH threats and to determine

the scope of deployment health activities. Assume that occupational hazards will not 

significantly differ from those at home station. If the job at home station requires use of 

PPE, so will the job while deployed. Home station engineering controls may not be 

available while deployed. Therefore, use of PPE may be required even if not required 

at home station.
6.L. (4) Submit completed PLHA to military exposure surveillance library (MESL).

6.M. Psychological Factors

6.M. (1) Mental health information, to include deployment-related stressors, 

suicide risk, and traumatic stress should be provided to all personnel prior to and 

during deployment. All personnel should be aware of deployment-related stress and 

injuries, their signs/symptoms, and how to seek final help for themselves or their fellow 

Service Members to include methods for mental health referral. Personnel should be

cognizant of sleep discipline and the impact of alcohol misuse.

6.M. (2) Because of the tremendous loss of life, serious injuries, missing and 

separated families, and destruction of whole areas often associated with disasters, it is 

important that personnel involved in relief operations recognize the situation they

encounter may be extremely stressful.

6.M. (3) Pre-existing behavioral health problems can be a very significant factor 

and must be considered in the assignment of individuals to high stress positions.

Treatment for Behavioral Health conditions in the AOR is very limited. This includes

pre-existing conditions such as current substance abuse and suicidal ideations. 

6.N. Other Non-Battle Injury

6.N. (1) Crime, terrorism, and chemical, biological, radiological, and nuclear 

(CBRN) threats. The risk of deliberate use of force, violence, or CBRN agents is 

intrinsically difficult to quantify or predict. Personnel awareness of current threat 

situation isparamount to prevent and/or rapidly contain deliberate actions against the 

health of U.S. forces. Prior to deployment, units should contact the embassy regional 

security officer or equivalent to obtain the latest location-specific threat information. 

Although NCMI assesses the risk as low, operational medical personnel should be

aware that several diseases endemic in the USSOUTHCOM AOR constitute pathogens 

potentially suitable for deliberate attacks. Deployed medical personnel should be 

trained on the signs, symptoms, medical countermeasures, and post-exposure 

treatments associated with CBRN health threats. Medical personnel should review 

disease and injury (D&I) data to identify potential CBRN exposures and detect any 

trends of concern and report through the appropriate command channels.

6.N. (2) Injuries (work and recreational).

6.N. (2)(a) Work-related injuries as well as sports and other recreational injuries 

can have a significant negative impact on mission effectiveness. Command emphasis 

of safety awareness is important.

6.N. (2)(b) Poor road conditions combined with variable driving experience of 

foreign nationals significantly increase the risk of motor vehicle accidents. Personnel 

should drive defensively, must always wear seat belts, and ensure vehicles are in good 

working order. Personnel should drive only during daylight hours and never alone.
6.N. (2)(c) The risk of physical trauma during and after a natural disaster is high. 

Persons who anticipate the need to travel to disaster areas should wear appropriate

PPE in these areas.

6.N. (3) Other conditions

6.N. (3)(a) Community-acquired methicillin-resistant staphylococcus aureus (CAMRSA). In forward-deployed settings, high-density living environments may result in 

prolonged close person-to-person contact and lapses in personal hygiene. These living 

conditions create ideal conditions for MRSA transmission. Primarily transmitted person 

to person through direct contact. The sharing of clothing, personal hygiene items or 

training equipment may also transmit MRSA.

6.N. (3)(b) Mold. Flooding, water intrusion, lack of adequate ventilation and 

moisture control are conditions that could lead to mold growth. Extensive water 

damage after major hurricanes and floods increases the likelihood of mold 

contamination in buildings. Commanders should take necessary actions recommended 

by PM personnel to limit exposure to mold and to identify and prevent mold- related 

health effects. Excessive exposure to mold-contaminated materials can cause adverse 

health effects in susceptible persons regardless of the type of mold or the extent of 

contamination. When mold growth is present, the removal and cleaning of 

contaminated materials must be handled IAW Ref X or service guidance for proper

procedures.

7. Pre-Deployment Health Activities

7.A. General

7.A. (1) Service component and JTF surgeons will ensure units conduct all 

deployment health requirements IAW Ref B, service-specific policy, and other

applicable guidance.

7.A. (2) Commanders must ensure unit medical planners and PM personnel 

carefully review all FHP relevant to the mission to obtain additional guidance and 

ensure full compliance with applicable policy and requirements.

7.A. (3) Service components and subordinate units will ensure PM assets are 

properly utilized/positioned in the AO to meet pre-deployment health risk assessment 

(HRA) requirements,support the mission, and help establish priorities pre, during, and

post deployment.

7.B. Pre-Deployment Health Risk Assessments

7.B. (1) OEH/ED threats can seriously impact a commander’s mission. This 

guidance considersOEH/ED hazards to be integrally related and addresses them

consistently.
7.B. (2) An overall HRA for the AO must be accomplished before deployment in 

the USSOUTHCOMAOR.

7.B. (3) PM personnel will conduct a preliminary hazard assessment as per para 

6 and integrate such data to the composite risk management (CRM) process to identify

OEH/ED hazards, assess their risks, determine appropriate countermeasures, and 

develop effective risk communication messages and materials.

7.B. (4) As part of the pre-deployment HRA, units will conduct OEH/ED studies at 

potential deployment sites to establish baseline conditions. These studies may include

environmental baseline surveys, OEHSA, industrial hygiene site assessments, PHLA, 

pre-deployment site surveys, and base camp assessments.

7.B. (5) PM personnel completing HRA must evaluate all information obtained 

and prepare a written and verbal HRA for the commander to include findings, 

conclusions, opinions, and recommendations.

7.C. Occupational and Environmental Health Site Assessments (OEHSA)

7.C. (1) IAW Ref B and Ref I, OEHSA are required for all operating locations 

occupied for 30 days or longer to identify, evaluate, and document deployment health

threats and countermeasures per Ref L and Ref M. An exposure of interest is anything 

that may adversely impact individual personnel’s future health, including but not 

necessarily limited to chemical contamination of soil, water, and/or air;microbial

contamination of water; noise; harmful fibers or particulates.

7.C. (2) Commanders must consider completing an OEHSA for deployment sites 

with high-risk health threat estimates or for longstanding locations where exercises and 

other activities routinely occur, regardless of deployment duration.

7.C. (3) OEHSA focus on collecting site-specific data to identify potential or 

actual exposure pathways during bed down, employ, and sustainment of deployed

forces.

7.C. (4) OEHSA provide a baseline to identify where future periodic sampling will 

be required based on the conceptual site model (CSM). Sampling data will be used to 

update the periodic occupational environmental model (POEM) (see para 8.G).

7.C. (5) The OEHSA shall be documented in the Defense Occupational and 

Environmental Health Readiness System (DOEHRS) database. If DOEHRS is not 

available, theOEHSA will be documented using DOEHRS standard templates to 

facilitate DOEHRS entry post deployment. Additionally, OEHSA shall be documented in

the MESL.

7.C. (6) Components and subordinate activities should:

7.C. (6)(a) Provide technical support and consultation to PM assets as necessary 

to completeOEHSA mission.
7.C. (6)(b) Query the MESL and DOEHRS to determine what sampling is needed 

at a given deployment site.

7.C. (6)(c) Ensure all OEHSA are coordinated with USSOUTHCOM SG, public 

health division prior to being forwarded to USAPHC.

7.C. (6)(d) Coordinate for sampling media and equipment as required and for 

analysis through USAPHC or another DoD certified lab. Components will request 

funding for and provide funding to PM assets part of their contingency and operational

planning.

7.D. Endemic Disease Site Assessments

7.D. (1) Conditions in the USSOUTHCOM AOR, such as poverty, 

underdevelopment, malnutrition, crowded living conditions, rudimentary public health 

infrastructure, and limited availability of healthcare, often result in ideal conditions for

infectious disease (ID) spread.

7.D. (2) Since USSOUTHCOM primary missions include non-combat roles such 

as security cooperation,humanitarian civic assistance exercises, humanitarian 

assistance/disaster relief (HA/DR), and peace support operations, ID will be the 

predominant enemy for U.S. military deployed in the USSOUTHCOM AOR.

7.D. (3) Units must identify diseases endemic to the AO and estimate the 

potential operational impact of such threats on overall unit readiness. Diseases with 

potential operational impact and/or health consequences to the deployed force must be

addressed.

7.D. (4) During site assessments, units should consult embassy and host nation 

health authorities to obtain further/latest information on local ED threats and validate 

preliminary hazard assessment findings. ED assessments must consider time frame of 

operations. Assessment prioritization should be based on seasonal prevalence, 

incubation period, and likelihood of exposure based on the natureof the mission.

7. E. Food and Water Safety

7.E. (1) Safe food/water sources, storage, preparation, handling, distribution, and 

consumption are critical in preventing and/or controlling food-borne/water-borne

diseases in deployed settings. For purposes of this guidance, the term food and water

include food, drinks, food ingredients, ice, and drinking water to include bottled 

individual and bulk containers. It also includes water in piped distribution systems to

the point of use to include related internal water storage and treatment.

7.E. (2) Tactical commanders on the ground must enforce the use of all required 

countermeasures including the use of DoD approved sources of food and drinking 

water IAW Ref U, Ref V, and Ref W.

7.E. (3) No source of drinking water (including ice) will be considered potable 

until properly tested and approved by qualified DoD medical/veterinary personnel IAW
DoD and service-specific guidance. The same applies to food. No food source will be 

utilized unless properly inspected and approved by qualified personnel IAW DoD and

service-specific guidance.

7.E. (4) The USPHC has a world-wide directory of approved commercial food 

suppliers/sources. Audits of these facilities have been conducted by USAPHC 

veterinary personnel. If audit compliant, facilities are placed on USAPHC Circular 40-1 

“worldwide directory of sanitarily approved food establishments for armed forces 

procurement”. See

https://phc.amedd.army.mil/topics/foodwater/ca/Pages/DoDApprovedFoodSources.as

px for a listing of approved sites in the USSOUTHCOM AOR.

7.E. (5) When requesting commercial audits of food establishments ensure 

enough lead time (typically 3-6 months) to meet the operational and logistical 

requirements of the mission.Request must be made through USSOUTHCOM SCSG or 

delegated to the appropriate component.

7.E. (6) Food & water risk assessments (FWRA) are conducted to support shortterm events and exercises outside the continental United States (OCONUS) in 

locations where no or insufficient DoD approved food sources are available and/or a 

logistics support tail is not available or feasible. FWRA are conducted primarily by 

veterinary service personnel. When veterinary service personnel are not available, an 

experienced and trained preventive medicine officer (Army MOS 72D, Navy PMO, or 

USAF PHO) may conduct FWRA for troop feeding in these areas. A FWRA does not 

yield an approved source; it is a health risk assessment and mitigation tool for tactical 

commanders to decide whether to allow troop feeding from non-approved caterers,

restaurants, foreign military dining facilities, etc.

7.E. (7) When requesting FWRA ensure enough lead time (typically 90 days) to 

meet the operational and logistical requirements of the mission. Request must be 

made through USSOUTHCOM SCSG or delegated to the appropriate component.

7.E. (8) Tactical commanders on the ground will ensure the necessary security to 

protect against intentional tampering or unintentional contamination of drinking water, 

food supplies, and food service operations under DoD control. Continual verification of 

quality and periodic inspection of storage and preparation facilities are required and will 

be carried out onsite by a U.S military medical authority IAW service-specific

guidelines.

7.E. (9) As a standard measure, consumption or individual purchase of local food 

and water is prohibited. However, it is recognized that at times, U.S. forces may need 

to eat local foods with community leaders and residents.

7.E. (9)(a) Although eating local foods may be good for building relationships, it 

frequently carries significant risk. Tactical commanders on the ground are responsible 

to consult with supporting preventive medicine and/or veterinary personnel about 

health risks that may result from eating local foods available at a particular

location/event.
7.E. (9)(b) If after weighing risks the tactical commander on the ground, approves 

consumption, then personnel should be briefed on risks involved and provided with 

information on making educated choices regarding the types of local food they can eat 

to help reduce their risk of foodborne illness. A variety of downloadable training 

resources regarding consumption of local foods during deployment are available on the 

USAPHC website (http://phc.amedd.army.mil/topics/foodwater/pages/default.aspx) 

7.E. (10) During disaster or emergency response, local foods are in short supply 

and need to be made available to fulfill the need of local civilians. As a result, local 

procurement of food is prohibited unless authorized by higher HQ.

7.F. Pre-Deployment Health Threat Briefing

7.F. (1) All personnel deploying or traveling to the USSOUTHCOM AOR must 

receive a pre-deployment health threat and countermeasures briefing within 30 days of

expected date of arrival in theater.

7.F. (2) Qualified medical personnel must brief all deployers and travelers on 

anticipated locationspecific health threats and exposures, relevant countermeasures, 

and their employment, plannedhealth surveillance monitoring, and the overall

operational risk management program.

7.F. (3) At a minimum, content of brief will include endemic diseases, vectorborne disease countermeasures, food and water borne disease prevention, STI, 

endemic flora and fauna hazards,environmental conditions, OEHS, personal/dental 

hygiene, motor vehicle and general safety, personal health and fitness, and operational

stress control.

7.G. Health Risk Communications Plan

7.G. (1) Units will develop a plan to communicate to commanders, health 

professionals, and personnel the nature, magnitude, and significance of potential 

OEH/ED health risks (including actual and potential exposures) adequately and 

accurately in the AO. Plan should specify the means of delivery and development of 

key messages and describe the potential or anticipated impact of possible threats on

force health.

7.G. (2) During all phases of deployment, units will provide health information to 

educate, maintain fit forces, and change health related behaviors for the prevention of 

disease, illness, and injury due to risky practices and unprotected exposures.

7.G. (3) Continual HRA’s are essential elements of the health risk communication 

process during the deployment phase. Medical personnel at all levels will provide 

written and oral risk communication products for medical threats, countermeasures to 

those threats, and the need for any medical follow- up.

8. During Deployment Health Activities
8.A. General

8.A. (1) During deployment health, activities should be based on the predeployment risk assessmentof the health threats for the AO and the specific

deployment location.

8.A. (2) During deployment health, activities begin when the advanced party or 

initial cadre personnel arrive at the deployment area. Activities should be updated as 

the deployment proceeds based on HRA’s, OEHSA, routine and incident-driven 

monitoring and sampling, and other health surveillance activities.

8.A. (3) Commanders and/or medical personnel will provide health information, 

during all phases of deployment, to educate, maintain fit forces, and change health 

related behaviors for the prevention of disease, illness, and injury due to risky practices

and unprotected exposures.

8.A. (4) Commanders must ensure the integrity of field hygiene and sanitation 

and occupational health and safety programs.

8.B. Health Surveillance

8.B. (1) Unit commanders must ensure medical personnel conduct daily D&I 

surveillance, disease and injury reporting, pesticide, sanitation and food service 

surveillance, location specific OEHSA and systemic OEH hazard surveillance and 

other activities to detect any trends in the health of deployed personnel.

8.B. (2) During deployment, medical personnel will:

8.B. (2)(a) Validate and update preliminary hazard assessments.

8.B. (2)(b) Ensure environmental monitoring of air, water, soil, disease vectors, 

and radiation based on assessment of actual and/or potential medical threats at

deployed locations.

8.B. (2)(c) Ensure deployment health surveillance and OEH reporting, and data is 

entered into DOEHRS, if DOEHRS is not available, ensure submission to DoD or 

service-specific systems for further disposition and archiving IAW DoD, 

USSOUTHCOM and service specific policies. To the extent possible, electronic copies 

of all data, data summaries, final reports and investigations will be uploaded, at least

monthly, to MESL IAW Ref B.

8.B. (2)(d) Alert USSOUTHCOM, service chain of command, Armed Forces 

Health Surveillance Center (AFHSC), and NCMI (ncmiops@ncmi.detrick.army.mil) to 

any newly identified health threats, negative health trends or adverse events.

8.B. (2)(e) Investigate, report, and document all OEH and CBRN exposure

incidents within the incident reporting module of DOEHRS when available.
8.C. Disease and Injury (D&I) Surveillance

8.C. (1) Daily D&I event surveillance is required for all deployment for more than 

30 days to locations within the USSOUTHCOM AOR. For deployment less than 30 

days, daily D&I surveillance is at the discretion of the component commander or 

commander exercising operational control, based on the health risks. 

8.C. (2) D&I surveillance and reporting should begin at the time that health care 

delivery is initiated. However, D&I surveillance is required even in the absence of 

deployed U.S. medical personnel. Units will continuously capture data about individual 

and population health status, instances of D&I, medical interventions (such as 

immunizations and treatments), stress-induced casualties, combat casualties,and

medical evacuations.

8.C. (3) D&I event counts, rates, and trends are an important type of surveillance 

for use at all levels. Deployed medical personnel at each operating location must 

monitor and evaluate D&I event data at least once daily. Data for D&I surveillance 

derives from electronic patient records, sick call logs, safety mishap reports or other 

sources. Abnormal patterns or trends may indicate a problem that could negatively 

impact mission accomplishment and indicate the need for additional investigations, and

if validated, the need to implement appropriate FHP countermeasures.

8.C. (4) The list of D&I reporting categories, their definitions, and the essential

elements of the standard D&I report can be found in Ref K. 

8.C. (5) Service component and JTF surgeons are responsible for ensuring 

subordinate units are collecting the prescribed D&I data and reporting that data on a 

weekly basis, preferably through DoD and service specific automated systems that

feed into the joint medical workstation (JMEWS).

8.C. (6) For sites without patient electronic data collection systems, medical 

personnel will need to revert to manual surveillance procedures and submit a weekly 

summary report of D&I surveillance rates. Units must email D&I report in excel format 

to chain of command and USSOUTHCOM Surgeon (USSOUTHCOM.miami.sccc.mesg.uscsg@mail.mil or USSOUTHCOM.miami.sc-cc.mesg.sg@mail.smil.mil ). 

MEDSITREP in pdf or word format that include D&I reporting data are also acceptable.

8.C. (7) Medical personnel at all levels will analyze the D&I data from their unit 

and the units subordinate to them and make changes and recommendations as 

required to reduce and mitigate D&I.

8.C. (8) Service component and subordinate activity surgeons will submit to the 

USSOUTHCOM SG FHP division, at least monthly or more frequently as required, a 

summary report and trend analysis of D&I surveillance of service component activities

within the USSOUTHCOM AOR.

8.D. Reportable Medical Event (RME) Surveillance

8.D. (1) Units must report all occurrences of diseases and conditions listed in the 
armed forces reportable medical events (RME’s) guidelines & case definitions IAW Ref 

N.

8.D. (2) Units must all comply with the RME requirement IAW established 

service-specific systems. 

8.D. (3) Adverse medical events related to immunizations should be reported 

through RME if case definitions are met. All immunization related adverse events are to 

be reported through the vaccine adverse events reporting system (VAERS) at

http://www.vaers.hhs.gov. 

8.D. (4) RME reporting is to occur as soon as reasonably possible after the event 

has occurred.Certain events are considered urgent RME, and immediate reporting is

required.

8.D. (5) Units are required to copy USSOUTHCOM SG for the following RME at 

(USSOUTHCOM.miami.sc- cc.mesg.uscsg@mail.mil: Anthrax; Botulism; CBRN and 

TIC/TIM OEH exposure; cold weather/heatinjuries; Chikungunya, Dengue Fever;

Hantavirus disease; Hemorrhagic Fever; Hepatitis B or C, HIV; Malaria; Measles; 

Meningococcal disease; Norovirus; Plague; Pneumonia, Eosinophilic; Rabies, Human;

Streptococcus, Invasive Group A; Tetanus; Tuberculosis, Pulmonary; TyphoidFever;

Varicella. 

8.D. (6) Service component and JTF surgeons are responsible for ensuring 

subordinate units are collecting the appropriate RME data and reporting that data 

through their service specific reportingmechanisms.

8.E. Patient Encounter Documentation/Deployment Health Record

8.E. (1) Deployed medical personnel must document all patient encounters and 

ensure service- specific procedures are maintained for appropriate archiving of health 

documents and records. 

8.E. (2) It is mandatory that copies of all inpatient and original outpatient medical 

encounter documentation (including medical treatment records provided to deployed

personnel by allies andcoalition partners of the U.S. be incorporated into the 

deployment health record (automated or hardcopy; DD form 2766 or equivalent).

8.E. (3) Individual dosimeter data and/or medical treatment information must be

documented in individual medical records using the SF form 600 (medical record – 

chronological record of medical care, rev. 6/97).

8.E. (4) Deployment health data will be collected and maintained in DoDapproved automated health information management systems. 

8.E. (5) Deployed medical personnel must ensure capture of the following 

information, at a minimum, on every patient encounter: patient's name, DoD ID#, 

gender, unit, unit identifier code, and duty location; type of visit (i.e. new vs. follow-up); 

primary (chief) complaint; final diagnosis (es), in order of importance related to the 

primary complaint injuries, which must be classification into recreation/sports, motor 
vehicle accidents, work/training, or other; final projected disposition, such asfull duty,

limited duty, transfer; D&I category.

8.E. (6) Medical personnel should use ICD-10 codes to best support medical 

event surveillance. Use of ICD-10 codes assists in the search for cases of reportable

diseases in healthcare encounter databases. Other ICD-10 codes may also be needed 

to find additional RME’s (occupational injuries) in these databases.

8.E. (7) Health surveillance records are protected information and must be 

maintained. 

8.E. (8) Electronic health event data collection systems that populate JMEWS will 

be used at all levels of medical care within the USSOUTHCOM AOR. Refer to para

below for more information on JMEWS.

8.F. Joint Medical Workstation (JMEWS)

8.F. (1) Deployed units will use JMEWS as the primary data entry point for 

weekly D&I reporting within the USSOUTHCOM AOR. Shipboard units should utilize 

SAMS or TMIP-M for D&I reporting and fixed MTF’s should utilize AHLTA or MHS 

GENESIS.

8.F. (2) For sites without patient electronic data collection systems, but with 

SIPRNET access to JMEWS, the Annex Q reporting portion of JMEWS is available for 

input of local data for review by command chain and USSOUTHCOM. 

8.F. (3) Service component and subordinate surgeons will ensure all units apply 

for JMEWS access prior to deploying and complete on-line training. Units may also 

coordinate training with army medical communications for combat casualty care (MC4) 

athttp://www.mc4.army.mil . 

8.F. (4) Component and subordinate activities surgeons will ensure that deployed 

medical unit submit a joining and exiting report via the JMEWS portal to establish and 

disestablish the deployed unit and to ensure medical records are assigned correctly. 

8.G. Periodic Occupational and Environmental Monitoring Summary (POEMS)

8.G. (1) Authority. POEMS is a joint approved product used to address 

environmental exposure documentation requirements.

8.G. (2) Timeframe. POEMS will be created and validated for every major 

deployment site at least annually. In general, POEMS are a summary of information 

reflecting a year or more of OEH data to ensure adequate collection of exposure

information.

8.G. (3) Classification/publication/access. POEMS will be unclassified but posted 

on the password protected MESL where joint OEH surveillance data and reports are 

stored. The POEMS template can be found at http://phc.amedd.army.mil.
8.G. (4) Responsibilities. Service components and JTFs are responsible for 

ensuring POEMS are completed for sites in their respective AOR. They should develop 

site prioritization lists and enlist the support of service public health organizations (e.g.,

USAPHC) to draft the content of a site POEMS. The USAPHC oversees the data 

archival website for publication of final POEMS and associated documents; however, 

approval of "final" POEMS must come from the service component/JTF FHP officer

with input from PM resources in direct or general area support.

8.H. Incident Response & Reporting (OEH Exposures/Outbreaks, Disease

Outbreak, CBRN)

8. H. (1) Medical personnel will keep their chain of command and 

USSOUTHCOM surgeon informed of any significant disease outbreaks, negative

health trends or adverse events. Please note that all illnesses requiring hospitalization 

and/or evacuation must be reported to their chain of command and USSOUTHOM 

surgeon.

8.I. Field Sanitation

8.I. (1) Not all potential sources of infection or illness can be countered with 

vaccinations or prophylactic medications. The best defense against these threats is 

strict discipline in proper field hygiene and sanitation practices by personnel, leaders,

and units.

8.I. (2) Units must ensure their own health and disease prevention by strict 

enforcement of proper field sanitation and hygiene. Units are responsible for field 

sanitation routine requirements unless such services are contracted.

8.J. Pest Control Operations

8.J. (1) Commanders will conduct pest control operations using the integrated 

pest management program IAW Ref S.

8.J. (2) Vector surveillance and control must be a part of all operational planning.

8.L. Waste control and disposal

8.L. (1) Commanders must ensure appropriate storage, use and disposal of

hazardous materials (human, hazardous, medical) IAW DA Pamphlet 710–7.

9. Post Deployment Health Activities

9.A. Post-Deployment Health Assessment (DD form 2796)

9.A. (1) All personnel who were required to complete a pre-deployment health 

assessment will complete a post-deployment health assessment on a DD form 2796 as 

close to the redeployment date as possible, but not earlier than 30 days before 
expected redeployment date or no later than 30 days after redeployment.

9.A. (2) Individuals who were not required to complete a pre-deployment health 

assessment, but who completed one due to multiple trips to theater each of 30 days or 

less duration, should complete a post-deployment health assessment at least once a 

year to document any potential exposures of concern resulting from any such travel

and the potential need for medical follow-up.

9.A. (3) All redeploying personnel must undergo a face-to-face health 

assessment with an independent practitioner (physician, physician assistant, nurse 

practitioner, advanced practice nurse,independent duty corpsman, independent duty 

medical technician, or special forces medical sergeant). The original completed copy of 

the DD form 2796 must be placed in the individual's medical record and transmit an

electronic copy to the DMSS at the AFHSC.

9.B. Post-Deployment Health Re-Assessment (PDHRA) (DD form 2900)

9.B. (1) All personnel who were required to complete a pre- and post-deployment 

health assessment must complete a PDHRA (DD form 2900) 90 to 180 days after 

return to home station. See www.pdhealth.mil

9.C. Additional Individual/Unit Requirements

9.C. (1) Post-deployment TB screening. Required for all personnel deployed to 

USSOUTHCOM AOR.

9.C. (2) Post-deployment serum specimens. Required for all service members 

(NOT Civilians) deployed to USSOUTHCOM AOR. Individuals must be informed if the

post-deployment serum sample will be tested for HIV.

9.C. (3) Biomonitoring. Required based on the deployment health threats, 

possible exposures, and available bioassays. 

9.C. (4) Post-deployment health debriefings and risk communications. A health 

threat de-briefing must be provided to redeploying or redeployed DoD personnel during 

in-theater medical out- processing or following a deployment to the USSOUTHCOM

AOR.

9.C. (5) Post-deployment medical surveillance. Commanders are responsible to 

ensure appropriate medical surveillance should be conducted to detect emerging 

(latent) health conditions on redeployed personnel.

9.D. Post-Deployment OEH Activities

9.D. (1) Units will submit any remaining OEH reports and data including 

monitoring and sampling results for air, water, soil, and noise; vector surveillance; toxic 

industrial chemicals or materials; and veterinary public health including food safety 

data that were not submitted previously to MESL for archiving. This includes but it is 

not limited to environmental sampling reports, industrial hygiene reports, PM unit 
SITREPS, veterinary service food and bottled water sanitation audit reports, veterinary 

laboratory test results, disease vector surveillance reports, pest management records,

health surveillance data, monitoring/sampling data, field monitoring data, specific 

reports/documents,reports of investigations/evaluations pertaining to potential OEH

exposure hazards, field water quality assurance surveys and monitoring data, pest 

surveillance surveys/reports, noise surveys, radiation surveys/monitoring data, 

entomological surveys, infectious/endemic disease reports, polymerase chain reaction

(PCR) results.

9.D. (2) Ensure all OEH sample results are analyzed for the potential medical 

follow-up and to contribute to lessons learned and future operational reports.

9.D. (3) Medical follow-up must be appropriately documented to address OEH 

concerns related to the review of responses on the DD form 2796 in the health record.

9.E. After Action Reports

9.E. (1) Commanders must comply with operation-specific guidance to document 

any OEH exposures during the deployment and any health lessons learned during the 

deployment. Documentation is in the form of official after-action reports such as the 

joint uniform lessons learned system, cruise reports, etc.

9.E. (2) This timely feedback allows medical personnel to provide health risk 

assessments that are based on the most accurate and up-to-date information and

intelligence available.

9.E. (3) These reports should be submitted within 60 days of the conclusion of a 

deployment via the operational chain of command IAW theater information policy. 

Copies should be forwarded to NCMI, Joint Lessons Learned Information System 

(JLLIS), service-specific medical lessons learned, future plans, and knowledge 

management as required.
APPENDIX A

References

1. Ref A: DHA-PI 6200.05, Force Health Protection Quality Assurance (FHPQA) 

Program, 02 May 2018.

2. Ref B: AR-40-5, Army Public Health Program, 12 May 2020.

3. Ref C: DHA-PI 6490.03, Deployment Health Procedures, 17 Dec 2019.

4. Ref D: USSOUTHCOM Regulation 40-501, Medical Suitability Screening, 07 Jun 

2018 (in conjunction with CY 2022 updates). 

5. Ref E: Clinical Practice Guidance for Deployment-Limiting Mental Disorders and 

Psychotropic Medications, 07 Oct 2013.

6. Ref F: AR 40-562, BUMEDINST6230.15B/AFI 48-110_IP/CG COMDTINST

M6230.4G, Immunizations and Chemoprophylaxis for Prevention of Infectious 

Diseases, 07 Oct 2013.

7. Ref G: DoD ASD (HA) Memo, Guidance on Medications for Prophylaxis of Malaria, 

15 Apr 2013.

8. Ref H: AFPMB, TG 41, Rodent-Borne Diseases with Special Emphasis on 

Protection from Hantavirus, Dec 2020.

9. Ref I: DoD ASD (HA) Memo, Post-Deployment Rabies Risk Evaluation, 14 Nov 

2011.

10.Ref J: DoD USD (P&R) Memo, Policy on Access to Medical Services for Individuals 

Who Were Exposed to Rabies While in A Combat Theater, 18 Nov 2011.

11.Ref K: CJCSMCM 0028-07, Procedures for Deployment Health Surveillance, 02 

Nov 2007.

12.Ref L: DoDD 4715.1E, Environment, Safety, and Occupational Health (ESOH), 30 

Dec 2019.

13.Ref M: DoD USD (AT&L) Instruction 6055.05, Occupational and Environmental 

Health, 11 Nov 2008.

14.Ref N: Armed Forces Health Surveillance Branch, Armed Forces Reportable 
Medical Event Guidelines & Case Definitions, Jan 2020.

15.Ref O: DHA-PI 6025.10, Standard Processes, Guidelines, and Responsibilities of 

the DoD Patient Bill of Rights and Responsibilities in the Military Health System 

(MHS) Military Medical Treatment Facilities (MTFs), 20 Dec 2019.

16.Ref P: DoDI 5400.11, DoD Privacy and Civil Liberties Program, 29 Jan 2019.

17.Ref Q: DoD Regulation 5400.11, DoD Privacy Program, 14 May 2007.

18.Ref R: DoD ASD (NII) Directive 8500.01e, Information Assurance, 23 Apr 2007.

19.Ref S: DoDI 4150.07, DoD Pest Management Program, 26 Dec 2019.

20.Ref T: AFPMB TG 24, Contingency Pest Management Guide, 05 Aug 2021.

21.Ref U: DoDD 6400.04E, DoD Veterinary Services Program, 27 Jun 2013.

22.Ref V: AR40–657, NAVSUP 4355.4h/MCO P10110.31h, Veterinary/Medical Food 

Safety, Quality Assurance, and Laboratory Service, 21 Jan 2005.

23.Ref W: AFI 48-116, Food Safety Program, 11 Sep 2018.

24.Ref X: TG 278/Industrial Hygiene Public Health Mold Assessment Guide, Oct 2018.

25.Ref Y: DoDD 6025.19, Individual Medical Readiness, 12 May 2020.

26.Ref Z: DoD USD (P&R) Instruction 3020.41, Contractor Personnel Authorized to

Accompany the U.S. Armed Forces, 11 Apr 2017.

27.Ref AA: DoD Directive 1404.10, DoD Civilian Expeditionary Workforce, 23 Jan 

2009.

28.Ref BB: DoDI1100.21, Voluntary Services in the DoD, 27 Mar 2019.

29.Ref CC: DoDI 6485.01, Human Immunodeficiency Virus, 07 Jun 2013.

30.Ref DD: DoD USD (HA) Memo, Policy for Pre-and Post-Deployment Serum 

Collection, 14 Mar 2006.

31.Ref EE: DHA Procedural Instruction 6025.14, Active-Duty Service Member (ADSM) 

Erythrocyte Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency and Sickle 

Cell Trait (SCT) Screening, 06 Dec 2018.

32.Ref FF: DoDI 5154.30, Armed Forces Medical Examiner System (AFMES), 29 Dec 

2015.

33.Ref GG: DoD ASD (HA) Memo, Updated Policy for Prevention of Arthropod-Borne 

Diseases Among DoD Personnel Deployed to Endemic Areas,18 May 2007.

34.Ref HH: DoD Instruction 6420.01, National Center for Medical Intelligence (NCMI), 

8 Sep 2020.

35.Ref II: DoD ASD (HA) Memo, Guidance on Medications for Prophylaxis of Malaria, 

15 Apr 2013. 

36.Ref JJ: Joint Publication 4-02, Health Services Support, 26 Jul 2012.

37.Ref KK: DoD ASD (HA) Memo, Periodic Health Assessment Policy for Active Duty 

and Selected Reserve Members, 16 Feb 2008.

38.Ref LL: DoD USD (P&R) Memo, Policy Guidance for Medical Deferral Pending 

Deployment to Theater of Operations, 09 Feb 2006.

39.Ref MM: DoD Directive 6490.02E, Comprehensive Medical Surveillance, 28 Aug 

2017.

40.Ref NN: AFPMB, TG 36, Personal Protective Measures against Insects and Other 

Arthropods of Military Significance, Nov 2015.

41.Ref OO: DoD ASD (HA) Memo, Baseline Pre-Deployment Neurocognitive 

Functional Assessment Interim Guidance, 28 May 2008.

42.Ref PP: DoD USD (AT&L) Instruction 6055.12, DoD Hearing Conservation, 05 Mar 

2004.

43.Ref QQ: DoDI 4715.13, DoD Operational Noise Program, 28 Jan 2020.

44.Ref RR: DoD USD (AT&L) Instruction 4715.5g, Overseas Environmental Baseline 
Guidance Document, 15 Mar 2000.

45.Ref SS: DoDI 4715.18, Emerging Chemicals (EC) of Environmental Concern, 4 Sep 

2019.

46.Ref TT: DoDI 6200.02, Application of Food and Drug Administration (FDA) Rules to

DoD FHP Programs, 27 Feb 2008.

47.Ref UU: TB MED 530/NAVMED P-5010-1/AFMAN 48-147_IP, TRI-SERVICE 

FOOD CODE, 1 Mar 2019.

48.Ref VV: DHA-PI 6025.34, Guidance for the DoD Influenza Vaccination Program 

(IVP), 21 Aug 2020. 

49.Ref WW: Deputy Secretary of Defense Memorandum, "Updated Coronavirus 

Disease 2019 Guidance Related to Travel and Meetings," September 24, 2021.

50.Ref XX: Deputy Secretary of Defense Memorandum, “Rescission of August 24, 

2021, and November 30, 2021, Coronavirus Disease 2019 Vaccination 

Requirements for Members of the Armed Forces,” January 10, 2023.