Occupational Health Services and Employer Health in Montana | American Family Care

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Please consult federal and local laws and legal counsel for Occupational Health services related to employment.

Physicals (DOT and Non-DOT)

If the exam is for a regulated employer, it is completed in accordance with Department of Transportation federal regulations. As a service to our employers DOT physicals are completed electronically and reported to the National Registry of Certified Medical Examiners (NRCME). A DOT look-alike physical exam may also be performed for a non-DOT employee. The exam follows the DOT regulations for a physical exam even though it is for a non- regulated employee.

Tuberculosis (TB) Test

Purified Protein Derivative (PPD). The PPD skin test involves two steps: the injection of a small amount of purified protein derivative (PPD) solution under the first layer of skin of the forearm and an evaluation of the injection site conducted by the clinic at 48 and/or 72 hours to see if a local skin reaction has occurred. If follow-up is not made within the prescribed window 48/72 hrs. Step one must be resubmitted. If the TB Test is positive, or the person has had a positive TB test in the past, a chest X-ray will be done to determine if the person is contagious based on a normal/abnormal X-ray result.

TB 2-step test: The 2-step test detects individuals with past TB infection who now have diminished skin test reactivity. Visit day 1: PPD antigen is applied under the skin. Visit day 3: PPD test is read. If the first test is positive, a chest X-ray and evaluation is necessary. Visit day 7: 2nd PPD skin test is applied to those individuals whose first TB test was negative. Visit day 9: 2nd test is read. Positive 2nd test indicates TB infection in the distant past. A chest X-ray would then be needed for further evaluation.

TB blood tests (T-Spot): A blood sample is taken to determine if the individual is infected with TB bacteria. The tests measure the response of TB proteins when they are mixed with a small amount of blood. Only one visit is required to draw blood for the T-Spot test. Samples should not be collected on Saturday or Sunday or after courier pickup as occurred. The samples must be sent to the lab on the same day.

Vaccination

Hepatitis A vaccine is a vaccine used to prevent an infection of the hepatitis A virus. Two doses of the vaccine are needed for lasting protection. These doses should be given at least 6 months apart. Hepatitis A vaccine may be given at the same time as other vaccines.

Hepatitis B vaccine is a vaccine used to prevent an infection of the hepatitis B virus. This immunization vaccine is administered in a series of three vaccines—with the second dose given 4 weeks after the first and the third dose 5 months after the second.

MMR vaccine is a vaccine use to prevent measles, mumps and rubella (also called German measles) infections.

Tdap vaccine can protect adolescents and adults from tetanus, diphtheria, and pertussis.

Varicella vaccine is a live (attenuated) vaccine that protects against the viral diseases commonly known as chickenpox, Herpes zoster, and Postherpetic neuralgia.

Titers

A laboratory test measures the presence and number of antibodies in blood to determine immunity from a disease.

• MMR
• Varicella
• Hepatitis A
• Hepatitis B

Audiogram - Baseline

An audiogram is a standard way of measuring a person’s hearing. Most audiograms cover a range of 100 Hz to 8000 Hz (8 kHz), which encompasses the fundamental sounds of speech. The audiograms plot the threshold of hearing relative to a standardized curve that represents ‘normal’ hearing, in dB(HL). Audiograms are produced using test equipment called an audiometer, that presents different frequencies to the subject, usually over calibrated headphones, at any specified level. The levels are, however, not absolute, but weighted with frequency relative to a standard graph known as the minimum audibility curve, which is intended to represent ‘normal’ hearing.

OSHA Respirator Questionnaire

When OSHA requires a respirator, the employee must fill out a questionnaire as part of the medical evaluation to determine if the employee is physically/psychologically able to wear a respirator. The questionnaire content is mandated by the OSHA respiratory protection standard (1910.134) and must be reviewed by a Physician or Licensed Health Care Professional (PLHCP). Based on the questionnaire responses, the PLHCP may require additional testing including a physical exam, chest X-ray, EKG or pulmonary function test (PFT), to clear an employee for respirator use.

Pulmonary Function Test

Pulmonary function tests measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body’s circulation. In a spirometry test, you breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period. For some of the test measurements, you can breathe normally and quietly. Other tests require forced inhalation or exhalation after a deep breath.

Respirator Fit Test

The qualitative test is a pass/fail test relying on the subject’s voluntary or involuntary response to a challenge agent, i.e., taste, smell, or irritation. This test is suitable when workers wear a respirator with a fit factor less than 10,000.

Lift Tests\Back Evaluation

The Kraus-Weber (K-W) Test of Minimum Muscular Fitness has six components. This test measures several large muscle groups for flexibility and strength. The higher the degree of test rating, the greater presumably the muscular function of the body.

• Lift Test – 25 pounds The ability to lift a weight of 25 pounds.
• List Test – 50 pounds The ability to lift a weight of 50 pounds.

Vision

Ishihara Color Test measures red-green color deficiencies. The test was named after its designer, Dr. Shinobu Ishihara, a professor at the University of Tokyo, who first published his results in 1917. The test consists of several colored plates, called Ishihara plates, each of which contains dots appearing randomized in color and size. Within the pattern, the dots form a number visible to those with normal color vision and invisible, or difficult to see, for those with a red-green color vision defect. The full test consists of 38 plates, but the existence of a deficiency is usually clear after a few plates. Testing the first 24 plates gives a more accurate diagnosis of the severity of the color vision defect.

Jaeger’s Vision Test uses printed letters of different sizes to test the acuity of near vision.

Sellen Vision Test uses a Snellen chart. A Snellen chart is an eye chart used by eye care professionals and others to measure visual acuity. The traditional Snellen chart is printed with eleven lines of block letters. The first line consists of one very large letter, which may be one of several letters, for example E, H, or N. Subsequent rows have increasing numbers of letters that decrease in size. A person taking the test covers one eye, and reads aloud the letters of each row, beginning at the top. The smallest row that can be read accurately indicates the visual acuity in that eye.

Biometric Screening

Body Metrics Screening - Measurement of specified criteria for wellness program participation and/or employer criteria for specific job functions. The clinician will perform the indicated services and record the results. These results are noted in a medical review for adherence to federal guidelines and/or job specific requirements.

Wellness Screen - Lipid Panel plus Glucose

EKG - a transthoracic interpretation of the electrical activity of the heart over time captured and externally recorded by skin electrodes. It is a noninvasive recording produced by an electrocardiographic device.

Anthropometric Size Restrictions – Clinician performs multiple size measurements, i.e., weight, chest circumference, waist circumference, etc. per client specific instructions to ensure the employee meets the size requirements for an employer specific vehicle.

Chest X-Ray

1 view - A chest radiograph, commonly called a chest X-ray (CXR), is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are among the most common films taken, serving as a diagnostic of many conditions. They may be taken in different views depending on the presenting symptoms. This is a commonly ordered X-ray used to clear a person with a positive PPD/TB skin test. 1 view is PA (posteroanterior).

2 view - A chest radiograph, commonly called a chest X-ray (CXR), is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are among the most common films taken, serving as a diagnostic of many conditions. They may be taken in different views depending on the presenting symptoms. This is a commonly ordered X-ray to clear a person with a positive PPD/TB skin test. 2 view is PA/Lateral (posteroanterior/lateral).

Other Occupational Health Services:

Comprehensive Metabolic Panel - a panel of blood tests which serves as an initial broad medical screening tool. The CMP provides a rough check of kidney function, liver function, diabetic and parathyroid status, and electrolyte and fluid balance.

CBC with Differential - CBC stands for complete blood count. This is a lab test that counts the different formed elements- red and white blood cells and platelets.

Lipid Profile - part of a cardiac risk assessment to help determine an individual's risk of heart disease.