How do I get access to E-profile as a provider at Walter Reed?

1. Log into Joint Knowledge Online (JKO)
2. Search for the Medical Readiness Healthcare Portal Training
   • Course number DHA-US298
   • Time requirement: 2hrs.
3. Request access to the Medical Readiness Health Care Portal via the MODS User Management website.
   • This is on Page 8 of user guide.
4. Select the "Medical Readiness Health Care Portal" for Program Selection. NOT E-PROFILE.
5. Select Provider-Physician for user Role Selection
6. Add comment about your duties for Access Reason
7. Under Role Property Assignment Selection: Click Active Duty-> RHC ATLANTIC (RHCA)-> Bethesda-PDMIS
8. Request access to the system from Mr. Donnie Nieves (Office: 301-295-2666) by emailing your 1) Full Name and 2) DOD ID to Donnie.nieves.ctr@mail.mil.

How do I actually place an E-profile?

Watch this tutorial: https://youtu.be/V28UXnXisdM Courtesy of Dr. Rohul Amin!

What is the Army E-Profile system?

US Army’s electronic system for documentation of medical or psychiatric diagnoses, duty limitations, deployability and medical readiness. Providers communicate their recommendations regarding duty limitations to the Commanding Officer (CO). Commands will generally follow a provider's recommendation, however, the CO has the final authority to make the final decision regarding duty limitations.

What guidelines do I follow to place an E-profile?

Army Regulations

• AR 40-501 Ch. 3-33 (Behavioral Health)
• AR 40-502

What are the different types of E-profiles?

• Temporary: limitations up to 12 months, with 30-90 days being the most common
• Permanent: limitations lasting more than 12 months.
  • Requires two provider signatures.
  • Profiles affect deployability. A permanent profile may require a referral to the medical board or an administrative separation (more details in the medical board and administrative separation tabs).

When should I consider if a Service Member needs an E-Profile?

At every behavioral health encounter! Consider placing a profile for:

• Initating new psychiatric medications
• Changing doses of psychiatric medications
• Psychiatric hospitalization

Who needs access to E-Profile?

Every behavioral health provider! If you are seeing patients for mental health concerns, you need access.

How do I log on to the E-profile website?

1) Log in directly via https://medpros.mods.army.mil/portal/#/ or 2) Log in with AHLTA:

• Go to the tabs on the left side of the screen
• Select "Army Readiness" > "eProfile"

What are some examples of appropriate limitations?

• "No deployment to an austere environment"
• "Requires 8 consecutive hours of sleep in a 24 hour period"
• "No alcohol"
• "No weapons/ammunition"
• “SM should remain near an MTF where definitive specialty care is available"

What are some examples of inappropriate limitations?

• "No 24 hour duty indefinitely"
• "No rotating shifts”
• "No formations"
• "No uniforms"
• "SM can only work from 0900-1700 hours"
• "SM cannot present to work until 1000 hours"

What is the Army Medical Evaluation Board (MEB)?

A panel of at least two physicians who review Service member's cases to determine the impact of medical conditions on a Service member's ability to perform the duties of his or her office, grade, rank, or rating. The Board consists of a minimum of two or more physicians trained in the Disability Evaluation System (DES). If the board is related to a psychiatric condition, one physician must be a psychiatrist.

Where do the MEB guidelines come from?

Army Regulations:

• AR 40-501 Chapter 3-33
• MEDCOM Policy 19-001

How does a Service member get placed into the MEB process?

A referral by you (a DoD provider)!

If a Service Member enters into the MEB, does this mean they will be discharged from the military?

No. Simply being entered into the MEB process does NOT necessarily mean that a soldier will be discharged from the Army. Service members may be found fit for duty and subsequently returned to duty.

What happens if the MEB decides that the Service member does NOT meet retention standards and/or will be unable to return to duty within one year?

The Soldier will be referred to the Physical Evaluation Board (PEB).

What happens if the MEB decides that the service member DOES meet retention standards & will be able to return to duty within one year?

The soldier will be returned to full duty.

What if the Service member disagrees with the decision made by the MEB?

The Soldier may accept or appeal the MEB's assessment. They may also ask for an independent medical review.

When should I consider placing a Service member into the MEB process?

DoD medical providers MUST refer Service members who have at least one of the following:

• One or more medical conditions that may, individually or collectively, prevent the Service member from reasonably performing the duties of their office, grade, rank, or rating, including those duties remaining on a Reserve obligation for more than one year after diagnosis
• A medical condition that presents an obvious medical risk fo the health of the member or to the health/safety of other members
• A medical condition that imposes unreasonable requirements on the military to maintain or protect the Service member and/or other members.

If a soldier is unable to complete their duty due to a behavioral health condition and their behavioral health condition is eligible per the AR & MEDCOM guidelines then a referral to the MEB is appropriate.

---

Where can I learn more about the MEB process?

Complete these JKO trainings: a. DHA-US021: Referral of SM into the DES b. DHA-US022: Documentation of the MEB Results c. DHA-US024: Evaluation of Disability Cases All behavioral health providers should complete these three JKO trainings to become more familiar with the process and to ensure that it is followed correctly. Another source includes this AMSUS presentation by Dr. Rohul Amin and Dr. Lee Hirt: https://youtu.be/p7smEXq5sHo

How do I make a referral to the MEB at Walter Reed?

Place a PERMANENT E-Profile (see E-profile tab for more details). If a patient already has a temporary E-profile, you may convert the temporary E-profile to a permanent E-profile.

What are the basic steps of the Disability Evaluation System (DES) process?

1. Referral
2. VA Claim Development and Disability Examinations
3. Medical Evaluation Board (MEB)
4. Physical Evaluation Board (PEB)
5. VA Rating
6. Appeals
7. Final Disposition

What is ADSEP?

ADSEP stands for Administrative Separation. It is the process of separation from the military for enlisted Army soldiers who do not conform to required standards of conduct, discipline, and performance despite efforts to counsel, retrain, and rehabilitate.

Where do the ADSEP guidelines come from?

AR 635-200: General guidance on ADSEP procedures MEDCOM Policies 19-001 Army ADSEP / DA FORM 3822 guidance for behavioral health providers.

When should I consider placing a Service member into the ADSEP process?

When - Service member has a behavioral health condition that interferes with performance of military duties & - the Behavioral health condition is eligible for ADSEP (per MEDCOM Policy 19-001) & - the Soldier has poor prognosis of recovery & has had ample opportunity for treatment to overcome their symptoms.

How do I make a referral for ADSEP?

1) Inform Commander of diagnosis, poor prognosis and recommendation for ADSEP IF THE COMMANDER AGREES, BH Prodiver will: 2) Inform soldier (explain ADSEP process, perform risk assessment) 3) Use DA Form 3822 & select appropriate chapter based on diagnosis 4) Submit BHAR packet and inform BHAR reviewer of case 3) Provide a copy of DA Form 3822 to the Commander.

What behavioral health conditions qualify for ADSEP?

If a service member enters the ADSEP process, does this mean they will be discharged from the Army?

Not necessarily. BHAR will use the information from the DA Form 3822 to make final decision regarding Soldier’s future military outcome.

If a service member is discharged from the Army via the ADSEP process, does this mean they will receive a dishonorable discharge?

No. In fact, most behavioral health ADSEPs are generally “honorable” unless misconduct is also present.

Who can fill out and complete a DA Form 3822?

a)Psychiatrist b)Clinical Psychologist c)Licensed Clinical Social Workers d)Psychiatric Advanced Practice Registered Nurses e)Trainees (i.e. Psychiatry residents, psychology externs) •The trainee’s supervisor must endorse the plan (i.e. “agree with diagnosis and plan”), cosign AHLTA note, and cosign DA FORM 3822.

What should be included in an ADSEP evaluation?

Records review (i.e. AHLTA and HAIMS) Clinical interview (within 3 months of recommending ADSEP) PLUS Review of required screenings for: - PTSD, - TBI (provider can refer positive screens to physician/TBI service) - Depressive disorder - Sexual assault (that occurred during military service), and - any other Behavioral Health condition requiring a MEB referral.

What screening tools need to be used in the ADSEP packet process?

As BHDP is linked to the BHAR website, screening for PTSD, TBI & Depressive disorder are automatically uploaded into BHAR. However, sexual assault screening is not linked to the BHDP website and there is a three-question screener found in MEDCOM Policy 19-001 that must be asked & then uploaded into BHDP separately.

What if the service member’s sexual assault screen is positive?

Indicate if in your clinical opinion, “the alleged assault(s) impact(s) the Soldier’s BH condition and/or otherwise contributes to the administrative separation.” If the alleged assault was reported to SHARP, indicate if the report was restricted or unrestricted.

Does a positive sexual assault screen prevent the ADSEP process from occurring?

The presence of a sexual assault incident does not prohibit ADSEP if the incident has not resulted in a BH condition warranting MEB referral (such as PTSD). The BH provider needs to determine if a sexual assault is a significant contributing factor to the reason for separation.

What if the service member has a documented case of TBI, depressive disorder, or behavioral health condition within the past 24 months?

The Service member must be evaluated and their prior BH condition must be documented as either “Not currently active (in remission)” or “Currently active but meeting AR 40-501 retention standards.” EXCEPT for “Service-related PTSD” (see below)

What if the Service member has a documented case of service-related PTSD?

If service-related PTSD is ever diagnosed, behavioral health providers can NOT recommend ADSEP for any behavioral health condition until after IDES finds the Soldier Fit for Duty.
These Service members must be referred to the MEB first, and only if they are found fit for duty can they be reevaluated for possible ADSEP.

Where can I learn more about the ADSEP process?

See the previously mentioned ADSEP guidelines & this additional resource.

What are tiptoes?

tiptoes are slipper socks! Made out of super stretchy terry cotton, they are meant to be worn indoors for lounging, playing,and running around! The non slip bottoms are perfect for toddlers and kids as they prevent slipping on any hard surfaces.

Are tiptoes good for babies and kids?

Yes! tiptoes are wonderful for babies and kids of all ages. tiptoes are super comfortable, mimicking the feel of being barefoot, while keeping tiny toes safe and warm. The perfect fit and the non slip bottoms make them ideal for running around on hard floors, ensuring there are no slips and falls!

What are tiptoes slipper socks made of?

tiptoes are made of 75% Cotton, 19% Polyester, 5% Polyamid.

Can you tell me more about the different sizes available?

Babies: We have 2 avaiable sizes: 0-12 months and 12-36 months. Please keep in mind that the 0-12 month sizing does not have the non slip bottoms, as this size is intended for pre-walkers. 12-36 months fits toddlers up to 3 years old. Kids: We have 3 sizes: Small: 3-4 year olds Medium: 4-6 years old Large: 7-10 years old Women: One size fits all Men: One size fits all

When can I expect to receive my tiptoes?

Typically we try to ship your order within 2-3 days! As these are hand sewn individually, they take some time to make them perfect before you receive them :)

How can I wash my tiptoes?

As these are handmade, please only handwash in cold water. No DRYERS please- only hang dry.

Can I customize my own pair?

This is a feature that will be available soon! For now if you have any special requests- feel free to send us an email: info@tiptoesus.com

What do the non-slip bottoms look like?

Do all sizes come with the non-slip bottoms?

All sizes except 0-12 months. The 0-12 months size is meant for our pre-walkers.

Baby sizing?

Babies that are not walking should be wearing our 0-12 month size, and walkers should be wearing 12-36 months.

How do I get access to E-profile as a provider at Walter Reed?

1. Log into Joint Knowledge Online (JKO)
2. Search for the Medical Readiness Healthcare Portal Training
   • Course number DHA-US298
   • Time requirement: 2hrs.
3. Request access to the Medical Readiness Health Care Portal via the MODS User Management website.
   • This is on Page 8 of user guide.
4. Select the "Medical Readiness Health Care Portal" for Program Selection. NOT E-PROFILE.
5. Select Provider-Physician for user Role Selection
6. Add comment about your duties for Access Reason
7. Under Role Property Assignment Selection: Click Active Duty-> RHC ATLANTIC (RHCA)-> Bethesda-PDMIS
8. Request access to the system from Mr. Donnie Nieves (Office: 301-295-2666) by emailing your 1) Full Name and 2) DOD ID to Donnie.nieves.ctr@mail.mil.

How do I actually place an E-profile?

Watch this tutorial: https://youtu.be/V28UXnXisdM Courtesy of Dr. Rohul Amin!

What is the Army E-Profile system?

US Army’s electronic system for documentation of medical or psychiatric diagnoses, duty limitations, deployability and medical readiness. Providers communicate their recommendations regarding duty limitations to the Commanding Officer (CO). Commands will generally follow a provider's recommendation, however, the CO has the final authority to make the final decision regarding duty limitations.

What guidelines do I follow to place an E-profile?

Army Regulations

• AR 40-501 Ch. 3-33 (Behavioral Health)
• AR 40-502

What are the different types of E-profiles?

• Temporary: limitations up to 12 months, with 30-90 days being the most common
• Permanent: limitations lasting more than 12 months.
  • Requires two provider signatures.
  • Profiles affect deployability. A permanent profile may require a referral to the medical board or an administrative separation (more details in the medical board and administrative separation tabs).

When should I consider if a Service Member needs an E-Profile?

At every behavioral health encounter! Consider placing a profile for:

• Initating new psychiatric medications
• Changing doses of psychiatric medications
• Psychiatric hospitalization

Who needs access to E-Profile?

Every behavioral health provider! If you are seeing patients for mental health concerns, you need access.

How do I log on to the E-profile website?

1) Log in directly via https://medpros.mods.army.mil/portal/#/ or 2) Log in with AHLTA:

• Go to the tabs on the left side of the screen
• Select "Army Readiness" > "eProfile"

What are some examples of appropriate limitations?

• "No deployment to an austere environment"
• "Requires 8 consecutive hours of sleep in a 24 hour period"
• "No alcohol"
• "No weapons/ammunition"
• “SM should remain near an MTF where definitive specialty care is available"

What are some examples of inappropriate limitations?

• "No 24 hour duty indefinitely"
• "No rotating shifts”
• "No formations"
• "No uniforms"
• "SM can only work from 0900-1700 hours"
• "SM cannot present to work until 1000 hours"

What is the Army Medical Evaluation Board (MEB)?

A panel of at least two physicians who review Service member's cases to determine the impact of medical conditions on a Service member's ability to perform the duties of his or her office, grade, rank, or rating. The Board consists of a minimum of two or more physicians trained in the Disability Evaluation System (DES). If the board is related to a psychiatric condition, one physician must be a psychiatrist.

Where do the MEB guidelines come from?

Army Regulations:

• AR 40-501 Chapter 3-33
• MEDCOM Policy 19-001

How does a Service member get placed into the MEB process?

A referral by you (a DoD provider)!

If a Service Member enters into the MEB, does this mean they will be discharged from the military?

No. Simply being entered into the MEB process does NOT necessarily mean that a soldier will be discharged from the Army. Service members may be found fit for duty and subsequently returned to duty.

What happens if the MEB decides that the Service member does NOT meet retention standards and/or will be unable to return to duty within one year?

The Soldier will be referred to the Physical Evaluation Board (PEB).

What happens if the MEB decides that the service member DOES meet retention standards & will be able to return to duty within one year?

The soldier will be returned to full duty.

What if the Service member disagrees with the decision made by the MEB?

The Soldier may accept or appeal the MEB's assessment. They may also ask for an independent medical review.

When should I consider placing a Service member into the MEB process?

DoD medical providers MUST refer Service members who have at least one of the following:

• One or more medical conditions that may, individually or collectively, prevent the Service member from reasonably performing the duties of their office, grade, rank, or rating, including those duties remaining on a Reserve obligation for more than one year after diagnosis
• A medical condition that presents an obvious medical risk fo the health of the member or to the health/safety of other members
• A medical condition that imposes unreasonable requirements on the military to maintain or protect the Service member and/or other members.

If a soldier is unable to complete their duty due to a behavioral health condition and their behavioral health condition is eligible per the AR & MEDCOM guidelines then a referral to the MEB is appropriate.

---

Where can I learn more about the MEB process?

Complete these JKO trainings: a. DHA-US021: Referral of SM into the DES b. DHA-US022: Documentation of the MEB Results c. DHA-US024: Evaluation of Disability Cases All behavioral health providers should complete these three JKO trainings to become more familiar with the process and to ensure that it is followed correctly. Another source includes this AMSUS presentation by Dr. Rohul Amin and Dr. Lee Hirt: https://youtu.be/p7smEXq5sHo

How do I make a referral to the MEB at Walter Reed?

Place a PERMANENT E-Profile (see E-profile tab for more details). If a patient already has a temporary E-profile, you may convert the temporary E-profile to a permanent E-profile.

What are the basic steps of the Disability Evaluation System (DES) process?

1. Referral
2. VA Claim Development and Disability Examinations
3. Medical Evaluation Board (MEB)
4. Physical Evaluation Board (PEB)
5. VA Rating
6. Appeals
7. Final Disposition

What is ADSEP?

ADSEP stands for Administrative Separation. It is the process of separation from the military for enlisted Army soldiers who do not conform to required standards of conduct, discipline, and performance despite efforts to counsel, retrain, and rehabilitate.

Where do the ADSEP guidelines come from?

AR 635-200: General guidance on ADSEP procedures MEDCOM Policies 19-001 Army ADSEP / DA FORM 3822 guidance for behavioral health providers.

When should I consider placing a Service member into the ADSEP process?

When - Service member has a behavioral health condition that interferes with performance of military duties & - the Behavioral health condition is eligible for ADSEP (per MEDCOM Policy 19-001) & - the Soldier has poor prognosis of recovery & has had ample opportunity for treatment to overcome their symptoms.

How do I make a referral for ADSEP?

1) Inform Commander of diagnosis, poor prognosis and recommendation for ADSEP IF THE COMMANDER AGREES, BH Prodiver will: 2) Inform soldier (explain ADSEP process, perform risk assessment) 3) Use DA Form 3822 & select appropriate chapter based on diagnosis 4) Submit BHAR packet and inform BHAR reviewer of case 3) Provide a copy of DA Form 3822 to the Commander.

What behavioral health conditions qualify for ADSEP?

If a service member enters the ADSEP process, does this mean they will be discharged from the Army?

Not necessarily. BHAR will use the information from the DA Form 3822 to make final decision regarding Soldier’s future military outcome.

If a service member is discharged from the Army via the ADSEP process, does this mean they will receive a dishonorable discharge?

No. In fact, most behavioral health ADSEPs are generally “honorable” unless misconduct is also present.

Who can fill out and complete a DA Form 3822?

a)Psychiatrist b)Clinical Psychologist c)Licensed Clinical Social Workers d)Psychiatric Advanced Practice Registered Nurses e)Trainees (i.e. Psychiatry residents, psychology externs) •The trainee’s supervisor must endorse the plan (i.e. “agree with diagnosis and plan”), cosign AHLTA note, and cosign DA FORM 3822.

What should be included in an ADSEP evaluation?

Records review (i.e. AHLTA and HAIMS) Clinical interview (within 3 months of recommending ADSEP) PLUS Review of required screenings for: - PTSD, - TBI (provider can refer positive screens to physician/TBI service) - Depressive disorder - Sexual assault (that occurred during military service), and - any other Behavioral Health condition requiring a MEB referral.

What screening tools need to be used in the ADSEP packet process?

As BHDP is linked to the BHAR website, screening for PTSD, TBI & Depressive disorder are automatically uploaded into BHAR. However, sexual assault screening is not linked to the BHDP website and there is a three-question screener found in MEDCOM Policy 19-001 that must be asked & then uploaded into BHDP separately.

What if the service member’s sexual assault screen is positive?

Indicate if in your clinical opinion, “the alleged assault(s) impact(s) the Soldier’s BH condition and/or otherwise contributes to the administrative separation.” If the alleged assault was reported to SHARP, indicate if the report was restricted or unrestricted.

Does a positive sexual assault screen prevent the ADSEP process from occurring?

The presence of a sexual assault incident does not prohibit ADSEP if the incident has not resulted in a BH condition warranting MEB referral (such as PTSD). The BH provider needs to determine if a sexual assault is a significant contributing factor to the reason for separation.

What if the service member has a documented case of TBI, depressive disorder, or behavioral health condition within the past 24 months?

The Service member must be evaluated and their prior BH condition must be documented as either “Not currently active (in remission)” or “Currently active but meeting AR 40-501 retention standards.” EXCEPT for “Service-related PTSD” (see below)

What if the Service member has a documented case of service-related PTSD?

If service-related PTSD is ever diagnosed, behavioral health providers can NOT recommend ADSEP for any behavioral health condition until after IDES finds the Soldier Fit for Duty.
These Service members must be referred to the MEB first, and only if they are found fit for duty can they be reevaluated for possible ADSEP.

Where can I learn more about the ADSEP process?

See the previously mentioned ADSEP guidelines & this additional resource.