Security Assistance Management Manual (SAMM), E-Change 554
Student Medical Examination Screening Update to Chapter 10

1) Replace C10.8.5. (and subsections) with the following:

C10.8.5. Student Medical Examination Screening. Pre-departure and pre-training medical examinations are required to ensure an IMS meets the health and fitness standards of requested training, and to ensure an IMS and Accompanying Family Members (AFMs) do not enter the U.S. while infected with a dangerous communicable disease, such as Tuberculosis, Ebola, Hepatitis, or a Coronavirus. An ITO will not be issued unless a physical exam for the IMS and every AFM is completed no more than three months prior to each person's arrival in the U.S. If an IMS is found after arrival to have a health or fitness problem that precludes participation in the training, and the problem cannot be mitigated before training starts, the IMS will be denied course entry and rescheduled for another course, or disenrolled and sent home.

C10.8.5.1. Training Location-Based Medical Screening Requirements.

C10.8.5.1.1. If U.S. sponsored training will take place in the U.S., all medical screening requirements in this chapter apply.

C10.8.5.1.2. If an IMS enters the U.S. for other than training and is subsequently invited to participate in U.S. sponsored training in the U.S. (and is issued an ITO), all IMS medical screening requirements in this chapter apply, including completion of DD Form 2808 (Report of Medical Examination) and DD Form 2807-1 (Report of Medical History). AFM medical screening requirements in this chapter will apply to all dependents not in the U.S. who will become AFMs, but only immunization and pregnancy screening is required for AFMs already in the U.S. on a valid visa.

C10.8.5.1.3. If U.S. sponsored training will take place at a U.S. military or USG-owned facility outside the U.S., medical screening requirements are the same as for training conducted in the U.S., and all IMS and AFM medical screening requirements in this chapter apply, including completion of DD Form 2808 and DD Form 2807-1.

C10.8.5.1.4. If U.S. sponsored training will take place at a non-USG facility in the IMS home country or in a third country, DoD and U.S. entry-related medical screening is not required. Nonetheless, an IMS must still meet all health and fitness standards specified for the training, and may be denied enrollment or disenrolled for failure to do so.

C10.8.5.1.5. In all cases when U.S. sponsored training will take place in a third country, the IMS and AFMs must satisfy the health insurance coverage and medical entry requirements of that country. The SCO should contact the training location SCO or U.S. embassy to determine the third country healthcare insurance coverage and medical screening requirements.

C10.8.5.1.6. Before processing an IMS for any course in any country, the SCO should verify the IMS home country has not imposed restrictions that could prevent or delay a timely and safe return after training is complete (e.g., because of COVID-19 re/entry or quarantine period restrictions). If the home country has imposed restrictions that could delay or prevent a return home, the SCO must seek appropriate MILDEP or CCMD concurrence prior to issuing an ITO.

C10.8.5.2. Medical Screening Requirements for All IMSs.

C10.8.5.2.1. DD Form 2808 and DD Form 2807-1. Unless the IMS home country is eligible for Medical Fast Track (see Section C10.8.5.5.), all IMS medical examinations, vaccinations, and health problems or issues will be recorded in English on DD Form 2808 and DD Form 2807-1. The SCO will provide the needed forms and, if needed, help the IMS with instructions for completing them.

C10.8.5.2.2. The IMS or PN home government is responsible for all costs of establishing IMS medical eligibility for travel to participate in DoD training, including examination, testing, or vaccination. If IMS training is funded by a DoD grant assistance program (e.g., IMET or FMF), any costs related to pre-travel examinations or treatment will not be funded by the grant assistance program.

C10.8.5.2.3. Certification of Immunization and Fitness. Either a PN MOD physician or a licensed practicing medical authority named on the U.S. embassy-maintained list of qualified practitioners must complete and sign DD Form 2808, block 82, certifying the IMS has had the immunizations listed in Table C10.T8. and meets the health and fitness standards of requested training.

C10.8.5.2.3.1. Only a qualified medical professional can determine which of the required immunizations listed in Table C10.T8. are medically appropriate for the IMS, based on age, medical history, and current medical condition. Only the MILDEP may approve a waiver for an IMS whose immunizations are not current.

Table C10.T8. Required Immunizations List 

C10.8.5.2.3.2. After all medical screening is complete and the IMS has been determined fit to enter the U.S. and free of a "communicable disease of public health significance" (as discussed on the U.S. Citizenship and Immigration Services (USCIS) website), a note will be placed by the SCO in DD Form 2808, block 73, that states, "[full name of person examined] is currently free of a communicable disease of public health significance." See Section C10.8.5.6. for health policy waiver procedures.

C10.8.5.2.4. Serological test for HIV.

C10.8.5.2.4.1. HIV test results will be included on DD Form 2808, block 49.

C10.8.5.2.4.2. HIV is not designated by the U.S. as a communicable disease of public health significance so HIV infection does not make a person inadmissible to the U.S. Even so, if an IMS is identified as being HIV-positive, an HIV waiver request must be submitted to the MILDEP and approved prior to that person's travel to the U.S. See Section C10.8.5.6. for health policy waiver procedures.

C10.8.5.2.4.3. For some training, a waiver might not be granted, depending on the extent of HIV infection and if other related conditions have developed, e.g., AIDS. The physical exam and laboratory results must be attached to the waiver request. The MILDEP will coordinate a waiver decision response with its medical office and with the training base or facility where the training is to take place.

C10.8.5.2.4.4. If an IMS travels to the U.S. for training, then leaves and returns for training within 12 months of the most recent negative HIV test, a new HIV test is not required unless the IMS exhibits symptoms of HIV or a clinical exam finds or indicates the possibility of HIV. A new HIV test is required if an IMS leaves and returns to the U.S. for training more than 12 months after the most recent negative HIV test.

C10.8.5.2.5. Screening for Tuberculosis (TB).

C10.8.5.2.5.1. Every IMS who attends resident training at any DoD facility must be screened by means of a Tuberculin Skin Test (TST), an approved Interferon Gamma Release Assay (IGRA), or a chest x-ray to determine if there is presence of TB. The test results will be listed in DD Form 2808, block 73.

C10.8.5.2.5.2. A TB diagnosis of Class A (meaning the disease is clinically active and communicable) makes a person inadmissible to the U.S. under current U.S. Centers for Disease Control and Prevention (CDC) and DoD policy guidelines.

C10.8.5.2.5.3. If the IMS is screened using the TST or IGRA, and the result is positive, the IMS must then have a chest x-ray to confirm the presence of active TB. If the TST or IGRA test result is negative for TB, a chest x-ray is not needed unless the IMS will be attending training that specifically requires a chest x-ray.

C10.8.5.2.5.4. If an IMS travels to the U.S. for training, then leaves and returns for training within 12 months of the most recent negative TB test, a new TB screening is not required unless the IMS has travelled to or through an area with a high-incidence/high-risk of TB, or exhibits symptoms of TB, or a clinical exam finds or indicates the possibility of active TB. A new TB screening is required if a person leaves and returns to the U.S. for training more than 12 months after the most recent negative TB test.

C10.8.5.2.6. Screening for SARS/Coronavirus and other USG-Designated Significant Health Threats. The rapid global spread in 2020 of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2, aka COVID-19) highlighted the need for an organized, rapid, and flexible U.S. response to similar events. The guidance in this section pertains specifically to COVID-19, but screening requirements and procedures should hereafter be essentially the same for all similar epidemic or pandemic events. Specific guidance pertaining to each unique health threat will be promulgated by the USG as appropriate at that time. This section will be updated as needed to reflect changes in U.S. and DoD policy.

C10.8.5.2.6.1. Until further notice, pre-travel medical screening will include COVID-19 testing for all IMSs. If symptoms of COVID-19 are present, travel to the U.S. will be delayed in accordance with guidance from the CDC and specific DoD directives. Generally, any person who tests positive for or is symptomatic of the disease will not be authorized to enter the U.S.

C10.8.5.2.6.2. The SCO will ensure the IMS home country MOD is aware of and understands current U.S. COVID-19 related travel restrictions and will work with the MOD, in coordination with the CCMD and IAs, to minimize the impact on the country's SC training plans.

C10.8.5.2.6.3. The SCO will request that IMS vaccination information (i.e., manufacturer, lot number, and date given) be given to the SCO as soon as possible after any version or number of doses of a vaccine is administered. Vaccination information will be included on a DD Form 2808.

C10.8.5.2.6.4. The SCO will maintain close contact with the Embassy team and CCMD medical personnel to ensure the SCO has the most current DoS and DoD guidance pertaining to COVID-19 related travel.

C10.8.5.2.6.5. Regardless of IMS medical screening results, prior to issuing an ITO, the SCO will ensure the IMS is not restricted from entering the U.S. in accordance with the CDC's list of Travelers Prohibited from Entry to the United States.

C10.8.5.2.6.6. Regardless of IMS medical screening results, prior to issuing an ITO, the SCO will review CDC Travel Health Notices and DoS Travel Advisories to ensure the IMS satisfies all U.S. entry requirements.

C10.8.5.2.6.7. Medical Fast Track (see Section C10.8.5.5.) does not apply to examinations for or vaccinations against COVID-19.

C10.8.5.2.6.8. Guidance pertaining to required actions, specific testing, and reporting for COVID-19 will be promulgated through appropriate DoD and DoS channels.

C10.8.5.2.6.9. For information about an IMS who exhibits or reports any significant SARS/Coronavirus (COVID-19) symptoms or has a positive COVID-19 test result while in training, see Section C10.20.11.

C10.8.5.2.7. Pregnancy Test. All female IMSs must submit results of a pregnancy test taken between 2 and 4 weeks prior to issuance of an ITO, and the test results will be listed in DD Form 2808, block 73. If the IMS is pregnant, the SCO must submit a health policy waiver request. See Section C10.8.5.6. for health policy waiver procedures. See Section C10.9.7. for information about Pregnancy-Related Healthcare Insurance Policy Coverage. Participants in Regional Center (RC) programs are not required to have a pregnancy test as a condition of attendance.

C10.8.5.2.8. Dental Examination. All IMSs must have a complete dental examination prior to issuance of an ITO, and a PN MOD dentist or licensed practicing medical authority identified on the U.S. embassy-maintained list of qualified practitioners must complete and sign DD Form 2808, block 82, certifying the IMS does not require care for cavities, infection, or oral disease. The SCO must review the IMS's dental report to ensure it supports immediate entry into training. Participants in RC programs are not required to have a dental examination or certification as a condition of attendance.

C10.8.5.3. Training-Specific Medical Screening Requirements. In addition to the medical screening requirements in Section C10.8.5.2., every IMS who attends training that has specific health and fitness prerequisites will complete all required physical examinations and medical screening in the home country. As a general policy, an IMS must meet the specified prerequisites before travelling to the U.S.; however, if a required exam cannot be completed in the home country, the IMS might be allowed to travel to the U.S., but will not be enrolled in the course until all medical prerequisites are met.

C10.8.5.3.1. If a course has special medical screening requirements (e.g., for flying or diving), the T-MASL must specify the special health and fitness prerequisites, and must state that the IMS must continue to meet the health and fitness standards for the duration of the training. The MILDEP must update the T-MASL as often as needed to ensure requirements are valid.

C10.8.5.3.2. If a required physical examination cannot be completed in the home country, or if the U.S. does not accept medical records from the IMS home country, or if the examination must be conducted by a U.S. military or civilian physician, the SCO will state in the ITO remarks section that the physical examination will be conducted at the first training installation at the home country's expense. The SCO will also obtain and provide information about where health screening bills are to be sent for payment. The only exceptions to billing the home country are for NATO countries, or pursuant to other memoranda of agreement that waive this requirement.

C10.8.5.3.3. The MILDEP may authorize a specialized physical (e.g., a flight physical) to substitute for a general medical exam only if the specialized physical includes all of the requirements outlined in Section C10.8.5.2. and is completed not more three months prior to arrival in the U.S.

C10.8.5.3.4. If a person travels to the U.S. for training more than once in a 12-month period, or must return to the U.S. multiple times a year for the same training (e.g., pilot simulator training), the SCO should coordinate with the IA to determine if the qualifying physical can be used to satisfy recurring medical requirements until either it expires or IMS health or fitness changes. ITOs will be annotated to reflect authorization to use previous physicals for new training activity. The annotation will include name and office of the approver, date of approval, and any limitations.

C10.8.5.3.5. IMSs who are medically screened and declared fit for training in accordance with this section (see Section C10.8.5.) are exempt from additional medical examinations and immunoassay urinalysis and blood screening programs prior to the start of training except as follows: when the medical exam is an established prerequisite for admission to training that involves exceptional physical activity or safety factors (e.g., flight or diving); when the required testing capability does not exist in the home country (e.g., centrifuge); or in conjunction with sick call or hospitalization to diagnose an IMS medical condition.

C10.8.5.3.6. If an IMS is found after arrival to have a health or fitness problem that precludes participation in the training, and the problem cannot be mitigated before training starts, the IMS will be denied course entry and rescheduled for another course, or disenrolled and sent home.

C10.8.5.4. AFM Medical Screening Requirements. Dependents who will travel to the U.S. as AFMs must undergo and complete all required medical screening before they can be added to an ITO, as described below.

C10.8.5.4.1. The IMS or PN home government is responsible for all costs of establishing AFM medical eligibility for travel, including examination, testing, or vaccination.

C10.8.5.4.2. All AFM medical examinations, vaccinations, and health problems or issues will be recorded in English on DD Form 2808 and DD Form 2807-1. The SCO will provide the needed forms and, if needed, help the IMS with instructions for completing them.

C10.8.5.4.3. Certification of Immunization and Fitness. Either a PN MOD physician or a licensed practicing medical authority named on the U.S. embassy-maintained list of qualified practitioners must complete and sign DD Form 2808, block 82 certifying the AFM has had the immunizations listed in Table C10.T8.

C10.8.5.4.4. Only a qualified medical professional can determine which of the required immunizations listed in Table C10.T8. are medically appropriate for the AFM, based on age, medical history, and current medical condition. Only the MILDEP may approve a waiver for an AFM whose immunizations are not current.

C10.8.5.4.5. After all medical screening is complete and the AFM has been determined fit to enter the U.S. and free of a "communicable disease of public health significance" (as discussed on the U.S. Citizenship and Immigration Services (USCIS) website), a note will be placed by the SCO in DD Form 2808, block 73, that states, "[full name of person examined] is currently free of a communicable disease of public health significance." See Section C10.8.5.6. for health policy waiver procedures.

C10.8.5.4.6. Serological test for HIV.

C10.8.5.4.6.1. Adult AFMs will be tested for HIV, and the test results will be included on DD Form 2808, block 49.

C10.8.5.4.6.2. HIV testing is not required for an AFM who is less than 15 years old unless the AFM exhibits symptoms of HIV; or a clinical exam finds or indicates the possibility HIV infection; or the person is believed to have been exposed to HIV.

C10.8.5.4.6.3. HIV is not designated by the U.S. as a communicable disease of public health significance so HIV infection does not make a person inadmissible to the U.S. Even so, if an AFM is identified as being HIV-positive, an HIV waiver request must be submitted to the MILDEP and approved prior to that person's travel to the U.S. See Section C10.8.5.6. for health policy waiver procedures.

C10.8.5.4.7. Screening for Tuberculosis (TB).

C10.8.5.4.7.1. Every Adult AFM must be screened by means of a Tuberculin Skin Test (TST), an approved Interferon Gamma Release Assay (IGRA), or a chest x-ray to determine if there is presence of TB. The test results will be listed in DD Form 2808, block 73.

C10.8.5.4.7.2. TB testing is not required for an AFM who is less than 15 years old unless the AFM exhibits symptoms of TB; or a clinical exam finds or indicates the possibility TB infection; or the person is believed to have been exposed to TB.

C10.8.5.4.7.3. A TB diagnosis of Class A (meaning the disease is clinically active and communicable) makes a person inadmissible to the U.S. under current U.S. Centers for Disease Control and Prevention (CDC) and DoD policy guidelines.

C10.8.5.4.7.4. If the AFM is screened using the TST or IGRA, and the result is positive, the AFM must then have a chest x-ray to confirm the presence of active TB.

C10.8.5.4.7.5. If an AFM travels to the U.S. then leaves and returns within 12 months of the most recent negative TB test, a new TB screening is not required unless the AFM has travelled to or through an area with a high-incidence/high-risk of TB, or exhibits symptoms of TB, or a clinical exam finds or indicates the possibility of active TB. A new TB screening is required if the AFM leaves and returns to the U.S. for more than 12 months after the most recent negative TB test.

C10.8.5.4.8. Screening for SARS/Coronavirus and other USG-Designated Significant Health Threats.

C10.8.5.4.8.1. Until further notice, COVID-19 medical screening for AFMs is the same as for IMSs. See Section C10.8.5.2.6.1. for details.

C10.8.5.4.8.2. For information about an AFM who exhibits or reports any significant COVID-19 symptoms or has a positive COVID-19 test result while in the U.S., see Section C10.20.11.

C10.8.5.4.9. Pregnancy Test. All female AFMs over the age of 18 must submit results of a pregnancy test taken between 2 and 4 weeks prior to issuance of an ITO. If an AFM is pregnant, the SCO must submit a request for a health policy waiver. See Section C10.8.5.7. for health policy waiver procedures. See Section C10.9.7. for information about Pregnancy-Related Healthcare Insurance Policy Coverage.

C10.8.5.5. Medical Fast Track. Medical Fast Track relieves an IMS or Regional Center activity participant of the necessity to undergo redundant medical testing and certification by allowing U.S. acceptance of alternate medical examination certification and history. Section C10.T9. lists countries approved for Medical Fast Track.

C10.8.5.5.1. Medical Fast Track is applicable only to personnel from an approved country who do not have a medical condition that requires maintenance medication or routine follow-up treatment or appointments during training (e.g., high blood pressure, diabetes, a cardiac condition, or allergies).

C10.8.5.5.2. Medical Fast Track waivers do not apply to examinations for, or vaccinations against, USG-designated significant health threats (e.g. COVID-19, SARS, Ebola), as explained in Section C10.8.5.2.6. Screening for SARS/Coronavirus and other Rapid-Spread Health Threats.

C10.8.5.5.3. Medical Fast Track does not apply to AFM medical screening, does not relieve the country of the requirement to comply with all medical screening requirements, and does not relieve the country or IMS of responsibility for providing healthcare coverage or insurance for the IMS and AFMs.

C10.8.5.5.4. A person from a Fast Track country may submit the home country medical examination and medical history forms (in English) to the SCO in lieu of DD Form 2808 and DD Form 2807-1.; however, MILDEPs must ensure the T-MASL indicates if DD Form 2808 and DD Form 2807-1. are still required in addition to the provided documents. If they are required, the SCO will work with the IMS to complete the forms and ensure they are ready when the IMS departs for training.

C10.8.5.5.5. The SCO is not required to review medical exams for personnel or from Fast Track countries; however, the SCO must provide certification in accordance with Section C10.8.5.2.3.2. by placing a note in the ITO that the person is from a Fast Track country, has been medically screened by an acceptable authority, is currently free of a communicable disease of public health significance, and meets the health and fitness requirements of the scheduled training activity.

C10.8.5.5.6. The Fast Track person must obtain and either forward or hand-deliver official copies of medical exams, medical history, and relevant test results to the medical treatment facility identified by the IMSO at the training location. Medical test results and records must be in English or be accompanied by an official English translation.

C10.8.5.5.7. A female IMS from a Fast Track country must submit results of a pregnancy test taken between 2 and 4 weeks prior to issuance of an ITO. If the IMS is pregnant, the SCO must submit a health policy waiver request. See Section C10.8.5.6. for health policy waiver procedures. See Section C10.9.7. for information about Pregnancy-Related Healthcare Insurance Policy Coverage. Participants in Regional Center (RC) programs are not required to have a pregnancy test as a condition of attendance.

C10.8.5.5.8. If an IMS from a Fast Track country is found after arrival to have a health or fitness problem that precludes participation in the training, and should have been identified during the screening process, DSCA (Defense Security Cooperation University/Enterprise Support Directorate/International Military Training and Education Division) will re-evaluate the country's Fast Track eligibility status.

C10.8.5.5.9. DSCA will review the Fast Track country list annually, in consultation with the CCMDs and the MILDEPs, to determine if countries should be removed or added. Current Fast Track countries are listed in Table C10.T9.

Table C10.T9. Fast Track Countries 

C10.8.5.6. Health Policy Waivers for IMSs and AFMs.

C10.8.5.6.1. A health policy waiver is used to suspend or mitigate a U.S. imposed limitation or restriction that would prevent a person from travelling to the U.S. or participating in U.S. sponsored training. Health policy waiver requests are typically submitted by the SCO through the CCMD to the appropriate MILDEP. The MILDEP POC coordinates health policy waiver requests with appropriate medical, training field activity, and school personnel. All health policy waiver requests are to be tracked, reported, and cited by the MILDEP as appropriate and required to ensure a consistent application of criteria to similar requests. A health policy waiver may only be granted based on criteria established by the MILDEP.

C10.8.5.6.2. IMS health policy waiver requests should include the ITO number and the schedule of training, dates, and locations. AFM health policy waiver requests should include both identifying IMS information and information about the IMS-dependent relationship. All health policy waiver requests will include copies of pertinent laboratory results and medical professional reports.

C10.8.5.6.3. Health policy waiver requests for individuals who test positive for communicable diseases that are not included in the Code of Federal Regulations (CFR) (e.g., Hepatitis-A, -B, and -C) will be considered on a case-by-case basis by the USCIS pursuant to Title 8 U.S.C. Section 1182(g) under INA, Section 212(g)(1) for "Inadmissibility Due to a Communicable Disease of Public health Significance." The waiver will be requested by the SCO, who will complete and submit USCIS Form I-601.

C10.8.5.6.4. Health policy waiver requests will not be approved for either a pregnant IMS or AFM under any program unless the IMS has documented and verified medical insurance or partner nation indemnification that covers all prenatal, childbirth, and postnatal care costs, in accordance with Section C10.9.7.3.

C10.8.5.6.5. All approved health policy waiver requests must be noted on the ITO.

C10.8.5.7. Privacy Matters.

C10.8.5.7.1. An individual's health information privacy will be maintained. Only people who need to know IMS or AFM medical information for official reasons are to have access to it.

C10.8.5.7.2. When health-related statistical or historical information reporting is required by policy or regulation, only a person's home country, WCN, and program type (e.g., IMET or FMS) will be used.

C10.8.5.7.3. Insofar as is practical, health policy waiver requests and other communications that contain IMS or AFM personal information should be sent via encrypted e-mail or handled the same way U.S. personnel PII and PHI is handled.

C10.8.5.7.4. IMS medical records are to be treated the same as U.S. Controlled Unclassified Information (CUI). SCOs should not require an IMS travelling to a U.S. school to complete a DD Form 2870, Authorization for Disclosure of Medical or Dental Information. When requesting health policy waivers, the SCO does not have to obtain a release of health information from the IMS.

C10.8.5.7.5. SCOs and IMSOs will not permanently keep IMS or dependent health or medical information, nor store such with IMS permanent training records. Physical copies of IMS and dependent medical records must be returned to the IMS or destroyed within 15 days after the IMS returns from training; digital copies of such records are to be permanently deleted IAW with DoD files management policy. This requirement will be noted in the CETPP, Appendix A, Paragraph 4a.

C10.8.5.8. Medical Screening Responsibilities.

C10.8.5.8.1. Country Team Responsibilities.

C10.8.5.8.1.1. Ensure required IMS medical and dental screening is completed in accordance with Section C10.8.5.2. and Section C10.8.5.3. Only accept required IMS exam results, records, and reports through official channels (i.e., from the home country MOD or a certified medical authority), not directly from the IMS.

C10.8.5.8.1.2. Ensure required AFM health screening is completed in accordance with Section C10.8.5.

C10.8.5.8.2. SCO Responsibilities.

C10.8.5.8.2.1. In coordination with the Embassy team, annually obtain or request from the PN MOD an updated list of licensed medical practitioners authorized to sign off on required medical forms.

C10.8.5.8.2.2. Review healthcare medical insurance policy coverage options to ensure compliance with DSCA policy, and review and coordinate available options with the home country and the IMS. Ensure healthcare coverage is verified by the MILDEP prior to issuance of an ITO or addition of AFM to the IMS ITO.

C10.8.5.8.2.3. Prior to issuing the ITO, obtain and thoroughly examine for completeness the medical and dental certification, DD Form 2808, DD Form 2807-1, and all required test results. If the examining physician or dentist identify a health condition that may require maintenance medication or routine follow-up treatment or appointments during training (e.g., high blood pressure, diabetes, a cardiac condition, or allergies), annotate in ITO item 15 that the IMS "has a health condition that may require maintenance medication or routine follow-up treatment." Submit and obtain approvals for applicable health waiver requests as needed. To protect IMS privacy, do not specify medical conditions on the ITO, only annotate that the IMS has a maintenance medical condition.

C10.8.5.8.2.4. If required, coordinate Fast Track requirements and procedures with the training location host nation, including identification of medical certification documentation that will be required (e.g., certification from host government, a letter from a physician, or copies of the home country test results).

C10.8.5.8.2.5. Assemble a copy of all required IMS and AFM medical documentation (with English translations) and an English version of required healthcare insurance policy documents, and place in a sealed packet. Advise the IMS to hand-carry the sealed packet for delivery to a U.S. health care provider, as directed by the IMSO. Give the IMS a second sealed copy of the English version of the medical insurance policy documents to give to the IMSO.

C10.8.5.8.2.6. Explain to the IMS the responsibilities listed in Section C10.8.5.8.3. and ensure the IMS knows who to contact (and how) if there is a medical emergency enroute to training.

C10.8.5.8.3. IMS Responsibilities.

C10.8.5.8.3.1. Notify the IMSO immediately about any IMS or AFM medical problem or issue that arises while in the U.S., including pregnancy.

C10.8.5.8.3.2. Become familiar with medical policies, procedures, and requirements explained or identified as important by the SCO; and seek guidance and assistance from the IMSO or local medical treatment facility (MTF) regarding any health-related issues or concerns.

C10.8.5.8.3.3. If instructed to do so by the IMSO, deliver the sealed packet of medical documents to the designated MTF; otherwise, keep all medical documentation in the sealed packed. If medical treatment is required and the MTF will not retain a medical file or documents, obtain the documents and keep with the original medical documents. Regardless of what an MTF does with medical records, in all cases, maintain a personal copy of health information while in the U.S. to use in case of medical treatment or emergencies.

C10.8.5.8.4. IMSO Responsibilities.

C10.8.5.8.4.1. Review the ITO for compliance with healthcare coverage and medical screening requirements, including TB and HIV test results. Immediately notify the MILDEP and SCO about any discrepancies.

C10.8.5.8.4.2. Review with the IMS the responsibilities listed in Section C10.8.5.8.3.; brief the IMS and AFMs about medical facilities and healthcare options available in the area; and ensure the IMS knows who to contact (and how) in a medical emergency.

C10.8.5.8.4.3. If appropriate, verify the IMS has delivered the sealed packet containing medical documentation to an MTF; otherwise, tell the IMS to store the sealed packet in a safe place until needed.

C10.8.5.8.4.4. While preparing IMS and AFM return travel, immediately notify the MILDEP about anything that could delay or prevent the timely and safe return to the home country, including pandemic-related (e.g., COVID-19) travel restrictions or catastrophic natural events (e.g., hurricanes, volcanos, or earthquakes).

C10.8.5.9. Regional Centers (RC).

C10.8.5.9.1. Medical Fast Track procedures will be applied to all countries for purposes of RC program participant processing. Participants traveling to an RC program or event in the U.S. with an ITO or a letter of invitation issued by the SCO or the RC will adhere to fast track procedures described in Section C10.8.5.5.

C10.8.5.9.2. Participants traveling to an RC program or event in the U.S. with an ITO or a letter of invitation issued by the SCO or the RC must meet DoS medical screening entry requirements as determined by the Consular Office in the U.S. Embassy. If approved by the RC Director, foreign military personnel who are assigned as foreign liaison officers (FLOs) or Exchange Officers with DoD, and are stationed within the local commuting area of a U.S. based RC, may attend RC events on a space-available basis without needing additional medical vetting.

C10.8.5.9.3. C10.8.5.9.3. Participants traveling to an RC program or event in a third country are responsible for satisfying all healthcare insurance coverage requirements of the country where the RC event is being held. The host RC will notify event participants about host country healthcare coverage requirements. For example, non-German participants must meet German entry requirements to attend an RC event at the Marshall Center. The participant's SCO should contact the training location SCO, the host RC, or the appropriate RC to determine specific healthcare insurance coverage requirements in the event nation.

C10.8.5.9.4. Participants traveling to an RC program or event do not require a dental exam or pregnancy test unless required by the host country.

2) Add C10.20.11. (and subsections) as follows:

C10.20.11. SARS/Coronavirus (COVID-19). The rapid global spread of COVID-19 in 2020 required significant changes to policies related to medical care and support for IMSs and their accompanying family members (AFMs) prior to, during, and following training, or in the event either is diagnosed with the disease. Applicable pre-training medical screening requirements are delineated in Section C10.8.5.2.6. This section pertains only to IMSs and AFMs who are already at a training location. Specific guidance pertaining to similar future health hazards will be promulgated by the USG as appropriate and may be included in or based on this guidance.

C10.20.11.1. IMS or AFM diagnosed with COVID-19.

C10.20.11.1.1. If an IMS or AFM exhibits or reports any significant COVID-19 symptoms or has a positive COVID-19 test result, DoD Component or installation representatives will obtain appropriate medical attention for the infected person in coordination with local DoD medical and public health personnel. A DoD Component representative (e.g., the training installation commander or MILDEP training program manager) will be immediately informed by the person responsible for the IMS (e.g., IMSO, local medical team, or SCO) in accordance with applicable privacy policies, so that appropriate contact tracing and public health safety measures may be initiated. Appropriate public health authorities will be notified by the Component representative in accordance with DoD guidance and U.S. state and local laws.

C10.20.11.1.2. Where an IMS or AFM obtains healthcare services will depend on that individual's eligibility for services provided by DoD medical personnel or a civilian medical provider. This guidance does not establish IMS eligibility to receive healthcare services from a DoD healthcare facility. For information about healthcare coverage eligibility see Section C10.9. Healthcare Coverage.

C10.20.11.1.3. The IMS and AFMs and anyone living with them will be isolated per current U.S. CDC, DoD, State, and local guidelines or directives. Funding associated with required isolation will be managed IAW the following.

C10.20.11.1.3.1. If an FMS-funded IMS is required to observe restricted movement protocols (RMP) (e.g., because of COVID-19) while enroute to or from, or enrolled in U.S. sponsored training, any consequent additional living costs are the responsibility of the PN, and may be paid by the PN directly, by the IMS directly and reimbursed by the PN, or if approved by DSCA, by the applicable FMS case.

C10.20.11.1.3.2. If an FMF or IMET-funded IMS is required to observe RMP while enroute to or from, or enrolled in U.S. sponsored training, the USG may pay any consequent additional living costs for the IMS only, in accordance with applicable program guidelines.

C10.20.11.1.3.3. If the home country requires the IMS and AFMs to undergo a quarantine period in the U.S. prior to departure as a condition of return, any additional living costs should be funded from the same source used to fund TLA during training.

C10.20.11.1.4. If an IMS or AFM who tests positive for COVID-19 is eligible for DoD-provided medical care, DoD medical personnel are authorized to provide care based on an assessment of the severity of the disease, and will comply with all applicable laws, DoD guidance, and any written agreements between DoD and the IMS home country, including protection of personal or private health information. For information about healthcare insurance coverage, see Section C10.9. Healthcare Coverage.

C10.20.11.2. Post-training Travel Affected by COVID-19.

C10.20.11.2.1. When feasible, DoD personnel will help an IMS schedule post-training return travel with the best available routing to ensure a safe return home, keeping in mind pass-through country travel restrictions and testing requirements, which may require booking a more direct route in favor of the most economical fare.

C10.20.11.2.2. If an IMS is unable to return to the home country because of disease related travel restrictions the local installation will extend the duration of the ITO until safe travel is possible. IMSOs and DoD Components will coordinate with the SCO to amend ITOs while the IMS and authorized dependents wait for transportation. ITOs may not be extended beyond the time safe travel is available. Note that this guidance pertains only to ITO duration, not funding availability or authorization, which will need to be resolved in coordination with the home country.

C10.20.11.2.3. IMSOs and DoD Components are responsible for monitoring IMSs and authorized dependents who remain in the U.S. after completion of training. The IMSO may determine the best method for maintaining accountability of the IMS and dependents' location and welfare while they wait for home-bound transportation. IMSOs will ensure the IMS and authorized dependents do not depart the local training facility area until a complete flight home itinerary has been confirmed or other official arrangements have been made.

C10.20.11.2.4. IMSOs will report to the DoD Component any IMS or authorized dependent who does not comply with MILDEP monitoring requirements or instructions about where the IMS and authorized dependent are to wait for transportation.

C10.20.11.2.5. If the IMS and dependents decline local installation support while waiting for transportation, they must request support from the home country embassy or consulate before they depart the installation. In all cases, the IMS must inform the IMSO before leaving the training installation or risk being reported as an unauthorized absence.

C10.20.11.2.6. Some IMSs and authorized dependents may not be able to travel to follow-on training if MILDEP or local restrictions preclude such travel. If an IMS is unable to continue to follow-on training, the SCO will coordinate with the IMSO, MILDEP, or designated IA to return the IMS and authorized dependents to the home country as soon as safely possible.