Heal t h

YOUTH TREATMENT CENTERS

si bl e, j ust as a wel l - desi gned house enabl es W hi l e t he cost per squar e f oot of maj or r eno-
gr eat , i t i s i mpor t ant t o ar r ange t he i ndi vi dual
a mot her t o keep t r ack of her chi l dr en, ei t her vat i on can be 20 t o 30 per cent l ess t han new
r ooms so t hat t he r esi dent cannot del i ber at el y
i ndoor s or out . The ar chi t ect has at hi s di sposal const r uct i on, a wel l - pl anned new f aci l i t y of t en
i sol at e hi msel f f r om t he act i vi t i es of t he pr o-
t hr ee unobt r usi ve super vi si on met hods : aur al , needs l ess squar e f eet t han an exi st i ng bui l d-
gr am.
vi sual , and movement super vi si on . The r el a- i ng . Ul t i mat el y t he t ot al cost s of r enovat i on
" Dor mi t or i es and f our - man r ooms ar e of t en
t i on of cor r i dor s, wi ndows, and key r ooms and new const r uct i on wi l l not be f ar apar t . As
used, whi l e t wo- man r ooms ar e of t en di scour -
l i ke ki t chen and of f i ces, wi l l enabl e st af f per - a r ul e of t humb, say t hat i f r enovat i on cost i s
aged because of aggr essi on, t ur nover r at es,
sons t o hear i f not see t he act i vi t y of t he house . 75 per cent or mor e of compar abl e new con-
and homosexual i t y . I n t he dor mi t or y si t uat i on,
Open st ai r wel l s ( bui l di ng codes per mi t t i ng) st r uct i on, new const r uct i on i s pr ef er abl e si nce
t he st r ai ns of dai l y communal l i vi ng ar e mul -
and cour t yar ds car r y sounds . Sounds car r y i t can be compl et ed f ast er , wi l l have l ess con-
t i pl i ed . The suppl y of pr i vat e ' t er r i t or y" i s
messages . By l ocat i ng vendi ng machi nes pr op- t i ngency cost s, and can be desi gned much
at a mi ni mumand const ant l y subj ect t o aggr es-
er l y, t he cook i n t he i l l ust r at ed ki t chen ( Fi g . 1 ) mor e ef f i ci ent l y .
si on, t hef t , damage, et c . I n dor mi t or y desi gn,
t her ef or e, i t i s i mpor t ant t o gi ve t hought t o pr o- can keep t r ack of act i vi t y near t he door . Vi sual
super vi si on i s t he most di f f i cul t t o achi eve Mechani cal Equi pment ( H. V . A. C. , el ect r i cal , pl umb-
vi si on of easi l y i dent i f i ed and def ensi bl e t er r i -
t or y i n t he f or mof f ur ni t ur e, st or age, shel vi ng, wi t hout r esor t i ng t o l ong cor r i dor s, vi ew i ng, el evat or s) Savi ng exi st i ng equi pment may
panel s on bedr oomdoor s, et c . By usi ng har d be f al se economy f or t wo r easons . Fi r st , i t may
bed, t ext ur ed or col or ed f l oor sur f ace or change
mat er i al s i n key ar eas, sounds can be r ei n- i nhi bi t ef f i ci ent , ef f ect i ve pl anni ng . Second,
i n f l oor l evel s, cei l i ng hei ght s, et c . ( see Fur -
ni shi ngs, bel ow) . For most r esi dent s, t hei r f or ced and t r ansmi t t ed . The cont r ol of move- t he or i gi nal equi pment may be f aul t y . Check
sl eepi ng ar ea and bel ongi ngs const i t ut e t hei r ment t hr ough ar chi t ect ur al desi gn can en- exi st i ng mai nt enance and expense r ecor d
ent i r e wor l dl y possessi ons ; t her ef or e t he mai n- hance super vi si on . Judi ci ous pl acement of i f avai l abl e ; t hi s wi l l gi ve an i nkl i ng as t o past
ent r y, ki t chen, and l ounges- t he nat ur al gr avi - per f or mance . I nst al l i ng new mechani cal equi p-
t enance of t hese becomes ver y i mpor t ant . The
t at i on poi nt s of hungr y t een- agar s - - can ment i n an exi st i ng st r uct ur e i s cost l i er t han
di agr am( Fi g . 5) i ndi cat es an appr oach t o cr eat -
ensur e a vi ew of movi ng peopl e by st af f . A i nst al l at i on i n a new st r uct ur e ; add 15 per cent
i ng an i mmedi at e pr i vat e zone ar ound t he bed,
wi ndow over l ooki ng a par ki ng l ot or an of f i ce of equi pment cost f or cut t i ng and pat chi ng .
pr ovi di ng easi l y def i ned space and l ockabi l i t y
and meet i ng per sonal st or age needs . by a st ai r way ar e ef f ect i ve means of super -
vi si on i n a smal l cent er . See accompanyi ng Code Checkl i st W hen consi der i ng t he r enova-
di agr ams ( Fi gs . 2, 3, and 4) . t i on pot ent i al of an exi st i ng buddi ng, some
Cont r ol basi c f act or s ought t o be consi der ed .
a. Mul t i pl e dwel l i ng codes and/ or soci al
Resi dent i al , communi t y- based pr ogr ams usu- ser vi ce r egul at i ons may pl ace r est r i ct i ons on
SPECI AL CONSI DERATI ONS
al l y r equi r e no over t physi cal const r ai nt s on t he number of occupant s per r oom, r egar dl ess
r esi dent s . No wal l s . No l ocked door s . I nst ead Renovat i ons of r oom si ze . Check appl i cabl e codes t o de-
of physi cal cont r ol , t hese pr ogr ams ai m i ni - t er mi ne t he bui l di ng' s capaci t y f or sl eep- i n
t i al l y at devel opi ng a sensi t i vi t y t o soci al con- Renovat i ons ar e at t r act i ve t o many agenci es occupant s .
t r ol i n yout hs and ul t i mat el y at a sense of because of t he publ i c pr essur e. f or act i on and b. The r equi r ed f i r e pr ot ect i on devi ces
sel f - cont r ol . The mechani sms f or cr eat i ng t he budget r est r i ct i ons on capi t al const r uct i on . ( al ar ms, smoke or t her mal det ect or s, spr i nkl er
t hese i nt er nal cont r ol s ar e gr oup t her apy ses- W hen oper at i ng wi t h a t i ght schedul e or a t i ght -
syst ems) ar e based on t he const r uct i on cl assi -
si ons, i ndi vi dual counsel i ng, exposur e t o com- f i st ed compt r ol l er , t he l ur e of r enovat i on i s f i cat i on of t he bui l di ng ; i t s ar ea and hei ght ;
muni t y l i vi ng f r om a st abl e, suppor t i ve r est - st r ong . Under such condi t i ons, r enovat i on and t he number , age, and physi cal condi t i on of
dent i al base, and a f r ankness and i nt i macy shoul d not be ext ensi ve . Mechani cal , el ect r i - i t s r esi dent s . W hen consi der i ng r enovat i on,
among st af f and r esi dent s . I n shor t , t he ai m i s cal , and pl umbi ng f aci l i t i es shoul d be i n good check t he ar ea, hei ght , and const r uct i on cl ass
t o si mul at e a domest i c envi r onment wi t h enough condi t i on t o r emai n, ot her wi se cut t i ng of your bui l di ng agai nst t he f i r e pr ot ect i on r e-
r esponsi bi l i t i es shar ed by yout hs and st af f . and pat chi ng f or a new syst em wi l l dr i ve up t he qui r ement s of t he bui l di ng code as wel l as
For t hi s r eason, r esi dent s must hel p i n t he cost . Ext ensi ve r enovat i on i s exceedi ngl y t i me- muni ci pal or st at e soci al ser vi ce r egul at i ons .
ki t chen, r esi dent s and st af f eat t oget her , and consumi ng and cont r act or s compet ent i n such Fi r e pr ot ect i on r egul at i ons f or publ i c agenci es
st af f l i ves on t he pr emi ses ( wi t h f ami l y or wi t h- wor k ar e scar ce and expensi ve . The onl y r ea- ar e st r i ct even when t her e ar e as f ew as seven
out ) . son t o consi der r enovat i on on a l ar ge scal e or ni ne r esi dent s i n a st andar d r esi dent i al
Physi cal cont r ol s i n t he t r adi t i onal sense ar e woul d be i f t he bui l di ng has speci al hi st or i c dwel l i ng ; cer t ai nl y t hey ar e f ar st r i ct er t han
usual l y not used. Never t hel ess, a cer t ai n mea- or est het i c val ue t o t he communi t y or t he pr o- r equi r ement s f or one- f ami l y dwel l i ngs .
sur e of super vi si on by t he st af f must be pos- gr am.
A new wat er ser vi ce and spr i nkl er syst ems
can be expensi ve i n ur ban ar eas . Addi t i onal
expendi t ur es f or a pump t o pr ovi de adequat e
wat er pr essur e may be needed . I n some ar eas,
a wat er met er must be at t ached t o t he spr i nkl er
syst em by l aw.
c . Egr ess r equi r ement s ar e usual l y st r i n-
gent . The ent i r e bui l di ng ( especi al l y i f mul t i -
st or i ed) shoul d have t wo means of egr ess vi a
f i r e- r at ed cor r i dor s and openi ngs . Assembl y
ar eas ( di ni ng, audi t or i um, l ect ur e) shoul d al so
have di r ect , unobst r uct ed egr ess . One egr ess
may be accept abl e i f pr ot ect ed by spr i nkl er s,
smoke or heat det ect or , and al ar m syst em.
d . Local f i r e depar t ment s may al so have
r ul es cal l i ng f or speci al equi pment f or gr oup
occupancy st r uct ur es : smoke det ect or s, st ar t "
syst ems, f i r e ext i ngui sher s, and per haps per -
sons t r ai ned i n emer gency t echni ques .
a . Roof t op ar eas, especi al l y i n ur ban si t es,
of t en have t he pot ent i al f or excel l ent r ecr eat i on
ar eas when pr oper pr ot ect i on, egr ess, and ar ea
r equi r ement s ar e met . Roof t ops may r equi r e
separ at e cer t i f i cat e of occupancy .
f . Fl oor s shoul d be capabl e of car r yi ng t he
l ar ge l i ve l oads r equi r ed f or assembl y ar eas
( di ni ng, audi t or i um, r ecr eat i on, cor r i dor ) . I t i s
of t en di f f i cul t t o pr ove l i ve l oad capaci t y t o a
bui l di ng depar t ment i f t he or i gi nal pl ans of an
ol d bui l di ng ar e l acki ng . Repl aci ng exi st i ng
Fi g . 4 Schemat i c pl an- bedr oom f l oor .
f l oor s wi t h capabl e f l oor s i s t r i cky and expen-
The concept i l l ust r at es a gr oup of pr i vat e ar eas or r ooms ar ound a common t er r i t or y, t he open yar d . Open st ai r wel l gi ves a
vi ew down each cor r i dor A counsel l or l i ves on each f l oor . The pl an i s open, yet each t er r i t or y i s def i ned . si ve .
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YOUTH TREATMENT CENTERS

Bui l di ng Codes These can be f l exi bl e. I f a

par t i cul ar bui l di ng i s wel l sui t ed t o your needs
and yet cannot be made t o compl y wi t h l ocal
codes i n cer t ai n cat egor i es, a r econsi der at i on
may be r equest ed based on need and on a wi l l -
i ngness t o pr ovi de ext r a saf eguar ds or conces-
si ons i n ot her cat egor i es of t he code.

Leasi ng
The l easi ng of smal l , sound r esi dences r eady
f or i mmedi at e occupancy has been done f or
seven- bed uni t s . Thi s i s t he qui ckest and l east
obt r usi ve means of f i l l i ng t he ar chi t ect ur al
needs of a pr ogr am, si nce t he housepar ent s
and r esi dent s move r i ght i n wi t hout di st ur b-
i ng t he physi ognomy of t he nei ghbor hood .
The deci si on t o l ease or buy wi l l be made ac-
cor di ng t o t he agency' s f i nanci al pol i cy . Leas-
i ng keeps t he pr oper t y on t he l ocal t ax r ol l s ;
t hi s can be a benef i t when devel opi ng r appor t
wi t h t he communi t y . The r el at i vel y modest
i nvest ment i n such a si t uat i on gi ves t he agency
gr eat f r eedom t o cope wi t h a changi ng nei gh-
bor hood, changi ng t r eat ment concept s, or bud-
get f l uct uat i ons by r et ur ni ng t he l ease or al l ow-
i ng i t t o l apse when t he f aci l i t y i s no l onger
vi abl e.

CONSTRUCTI ON, FURNI SHI NGS, AND SPECI AL

EQUI PMENT
Const r uct i on
" Gener al l y, sur f aces shoul d be f i ni shed t o
pr ovi de ease of cl eani ng or pai nt i ng, r esi st ance
t o heavy wear and def acement , f i r e r et ar dance,
end noi se dampeni ng. The gener al st ar kness of
Fi g. 5 Gr aphi c concept s of t erri t ory i n gr oup l i vi ng .
such sur f aces i n bedr ooms, cor r i dor s, st ai r Jai Undef i ned t erri t ori es . Def i ni t i on of t erri t ory var i es f r omoccupant t o occupant , dependi ng on hi s st at us wi t hi n t he peer
hal l s, et c ., can be r el i eved wi t h use of chr o- gr oup. (b) Def i ned t erri t ori es . Def i ni t i on of publ i c, semi - pr i vat e, and pr i vat ear eas i s accompl i shed by usi ng ar chi t ect ur al el e-
mat i c col or s and, i n t he l ounge ar eas ( f or ex- ment s . Ther ef or e, si ze and shape of pr i vat e t erri t ory are not dependent on i ndi vi dual ' s st at us . Pr i vat e ar eas can be
ampl e) , by use of car pet on f l oor s and wal l s . def i ned as zones wi t hi n a dor mi t or y or as i ndi vi dual r ooms al ong a cor r i dor . See accompanyi ng di agr ams . (c) Dor mi t or y
Youngst er s usual l y r espond t o unusual t ex- wi t h def i ned t erri t ori es Bed and l ockabl e st or age uni t s ( see enl ar ged sket ch) f or m pr i vat e t erri t ory zones al ong semi -
t ur es and st r ong col or s . Admi ni st r at or s usual l y pr i vat e wal kway . Wal kway can be def i ned by usi ng space t ext ur e, col or . I dl Pr i vat e t erri t ory .
 Heal t h

YOUTH TREATMENT CENTERS

I nst i t ut e sponsor s i nvent or i es of

do not . Sound dampeni ng i ncr eases t he i nt i - " Cl osed ci r cui t t el evi si on and vi deot ape Nat i onal
f aci l i t y f or gr oup t her apy sessi ons cur r ent cor r ect i onal pr ogr ams, r esear ch i nt o
macy of a r oom and l essens t he i nst i t ut i onal
" Mast er ant enna syst em cor r ect i onal modes, end demonst r at i on pr oj -
f eel i ng .
ect s . Cont act t he I nst i t ut e f or l i st of pr oj ect s
" Gl ass ar eas shoul d be kept smal l ; l ar ge " El evat or
and publ i cat i ons .
ar eas ought t o be t emper ed or wi r egl ass . W i n- " Gar bage di sposal or condenser
dow di mensi ons- openi ng si ze, hei ght above
f i ni shed f l oor - - shoul d r ef l ect t he mor e i nt i -
mat e st el e r equi r ed f or chi l dr en i n a domest i c
set t i ng .
" Har dwar e . The open nat ur e of r esi dent i al I NFORMATI ON RESOURCES
t r eat ment usual l y cal l s f or not hi ng mor e t han Publ i cat i ons
a st ur dy gr ade of domest i c har dwar e. Thi s wi l l Most agenci es pr oduce many unpubl i shed
depend on t he pr ogr amdi r ect or . Al l i ndi vi dual
Agenci es
but i nf or mat i ve paper s, monogr aphs, mem-
bedr ooms and of f i ces shoul d have key l ocks ; The f ol l owi ng agenci es ei t her oper at e com- or andums, et c . , deal i ng wi t h t hei r par t i cul ar
pr ovi de a mast er key f or st af f per sonnel . Bat h- muni t y- based, r esi dent i al t r eat ment cent er s appr oach . Theme ar e val uabl e and shoul d be
r oom pr i vacy i s kept i nt act nor mal l y, wi t h t hemsel ves or advi se on and r egul at e t he oper a- f er r et ed out . A r epr esent at i ve sampl i ng of pub-
door s on al l t oi l et st al l s . t i on of such cent er s . Cont act agenci es of a si m- l i shed mat er i al f ol l ows :
i l ar nat ur e i n your ar ea f or mat er i al , per mi ssi on
t o vi si t , and i nt er vi ews wi t h st af f and admi n-
i st r at i on . Most pr ogr ams ar e qui t e ent husi ast i c Desi gn f or Change
about vi si t or s . Those l i st ed ar e i nt ended onl y
as exampl es of such agenci es . The per sons Model Tr eat ment Pr ogr am
Fur ni shi ngs Br adl ey, Smi t h, Sal st r om
named ar e t hose wi t h whom t he aut hor has Nat i onal Counci l on Cr i me and Del i nquency
Domest i c f ur ni t ur e, st ur dy, ampl e, and col or - been i n communi cat i on . Cr ocker / Ci t i zens Savi ngs Bank Bui l di ng
f ul , f i l l s t he bi l l f or most ar eas, i ncl udi ng Sacr ament o, Cal i f .
di ni ng, l ounge, and gr oup r ooms . Bedr ooms A pr oj ect , sponsor ed by t he For d Foundat i on,
ar e di scussed bel ow. I n many pr ogr ams New Yor k
whi ch st udi es t he r est r uct ur i ng of t he ent i r e
r esi dent s bui l d t hei r own f ur ni t ur e as an econ- New Yor k St at e Di vi si on f or Yout h t r eat ment mi l i eu- st af f , cl i ent s, admi ni st r a-
omy measur e . Some admi ni st r at or s bel i eve 2 Uni ver si t y Pl ace t i on, ar chi t ect ur e .
t hat r esi dent s t ake bet t er car e of such f ur ni t ur e Al bany, N. Y. 12205
and equi pment t han of or di nar y i nst i t ut i onal Oper at es r ur al end ur ban pr ogr ams r angi ng
f ur ni t ur e . Admi ni st r at i ve ar eas r equi r e f i l e f r om7- bad uni t s t o 60- bed camps . The Non- Pr i son
cabi net s, t ypi ng desks, et c . , al l of whi ch shoul d
A New Appr oach t o Tr eat i ng Yout hf ul
f i t i nt o t he domest i c scal e .
New Yor k St at e Depar t ment of Soci al Ser - Of f ender s
vi ces Br uce Publ i shi ng Company
1450 W est er n Avenue Mi l waukee, W i s . 1970
Al bany, N. Y . 12203 I nt r oduct i on by Ri char d McGee,
I ndi vi dual Bedr ooms These shoul d have a wr i t i ng
Pr ogr am.
and r eadi ng sur f ace, cl ot hi ng st or age ( hangi ng Responsi bl e f or desi gni ng and oper at i ng publ i c Book ver si on of Model Tr eat ment
and f ol ded) , sui t case st or age, seat i ng f or t wo pr ogr ams and f or r egul at i ng and l i censi ng
or t hr ee, and a si ngl e bed . St or age ar eas shoul d pr i vat e pr ogr ams of var i ous si zes .
Sur vey of Hal f way Houses i n t he Uni t ed
have key l ocks, as shoul d t he r oom door s . St at es
Seat i ng and st or age mi ght be bui l t i n and/ or
i ncor por at ed i n t he ar chi t ect ur e ( a wi ndow
Cal i f or ni a Ol i ver J . Kel l er
seat , f or exampl e) . Ampl e t ack boar d and St at e of Cal i f or ni a Cent er f or St udi es i n Cr i mi nal Just i ce,
Chi cago, I l l . , 1966.
shel ves shoul d be pr ovi ded f or pi nups, post er s, Depar t ment of Cor r ect i ons
et c . For many r esi dent s, especi al l y young Cal i f or ni a Rehabi l i t at i on Cent er Yout hf ul Of f ender s at Hi ghf i el ds : An Eval -
peopl e, t hi s wi l l pr obabl y be t he f i r st t i me t hey P . O. Box 841 uat i on of t he Ef f ect s of Shor t - Ter m Tr eat -
Cor ona, Cal i f . 91720 ment of Del i nquent Boys .
have had a pr i vat e r oom; t he r oom i s consi d-
er ed an i ndi vi dual ' s " t er r i t or y" end as such Oper at es many t r eat ment modal i t i es wi t hi n H. Ashl ey W eeks
shoul d be suscept i bl e t o some r ear r angement a l ar ge compound end has exper i ment ed wi t h Ann Ar bor , Uni ver si t y of Mi chi gan Pr ess,
accor di ng t o hi s/ her i di osyncr asi es- of t en t he concept s i n i nnovat i ve i nst i t ut i onal l i vi ng . Ann Ar bor , Mi ch. , 1950.
ar r angement of a r oom wi l l gi ve t he st af f an
i ndi cat i on of t he occupant ' s char act er .
Fl or i da The Hi dden Di mensi on

St at e of Fl or i da Di vi si on of Yout h Ser vi ces Edwar d T. Hal l

311 Sout h Cal houn Anchor Books, Doubl eday & Company, I nc . ,
Gr oup Bedr ooms or Dor mi t or i es These shoul d pr o- Tal l ahassee, Fl a . 32304 Gar den Ci t y, N. Y. , 1969.
vi de t he same basi c " t er r i t or i al " needs as t he
St udy of pr oxemi cs, t he di st ance r egul at i ons
pr i vat e r ooms : sl eepi ng, si t t i ng, wr i t i ng/ r ead- Oper at es yout h pr ogr ams on a r esi dent i al
i ng, l ocked st or age, di spl ay sur f aces ( t ack scal e at sever al ur ban end subur ban l ocat i ons i n t he ani mal wor l d and i n man' s cul t ur e . A
and i s expandi ng t hese f aci l i t i es r api dl y . good, basi c book on spaces and t hei r mes-
boar d, shel ves) . The necessi t y f or easi l y i dent i -
f i ed and def ensi bl e t er r i t or y i s acut e i n i nst i t u- sages .
t i onal pr ogr ams, especi al l y i n communal l i vi ng
ar r angement s, si nce t her e i s l ess pr i vacy i n Ohi o
On Soci al Cont r ol and Col l ect i ve Behavi or
t hese ci r cumst ances . Conf l i ct bet ween r esi - I nt er nat i onal Hal f way House Associ at i on
dent s i s l essened when per sonal bel ongi ngs 2316 Auber ncr est Rober t Ezr a Par k
can be secur el y st or ed . Some pr ogr ams r emove Ci nci nnat t i , Ohi o 45219 Sel ect ed paper s, edi t ed end wi t h i nt r oduct i on
l ocks when t hey f eel t hat i nt r ogr oup t r ust has by Ral ph H. Tur ner ,
Or gani zat i on r epr esent i ng hal f way houses Uni ver si t y of Chi cago Pr ess, Chi cago, i l l . ,
been bui l t up. The ar chi t ect ur al sol ut i on t o t hi s of many modal i t i es, r un f or many t ypes o ca . 1967 .
t er r i t or i al quest i on has an i mpor t ant i mpact i ndi vi dual s by bot h publ i c and pr i vat e agenci es
on gr oup l i vi ng . I n a dor mi t or y si t uat i on, com- A good cent r al sour ce f or l ocat i ng pr ogr emi A good sampl i ng of t hi s soci ol ogi st ' s wor k
pact , f ol daway t er r i t or y pr ovi des one t ype of i n pr act i cal l y al l t he st at es of t he Uni on . and vi ews, i ncl udi ng concept s of soci al di s-
sol ut i on . See Fi g . 5 . t ance and human ecol ogy, bot h basi c and vi t al
t o ar chi t ect ur al desi gn .
Feder al

Speci al Equi pment ( Opt i onal ) Nat i onal Cl ear i nghouse f or Cr i mi nal Just i ce Ot her s Basi c r eadi ngs i n " soci al ecol ogy"
and Pl anni ng and behavi or can be f ound i n t he wor ks o1
" I nt er com bet ween st af f ar eas Depar t ment of Ar chi t ect ur e Er vi ng Gof f man, Humphr ey Osmond, Rober t
" Emer gency l i ght i ng and power syst em Uni ver si t y of I l l i noi s
Sommer , et al . , bot h i n book f or m and i n pe-
" Cent r al smoke det ect i on syst em and/ or 1102 W . Mai n St .
r i odi cal s .
f i re al ar m syst em Ur bane, 111 . 61601
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MULTI PHASI C HEALTH SCREENI NG CENTERS

GENERAL HI STORY OF MULTI PHASI C Dr essi ng Ar ea

SCREENI NG
Dr essi ng ar eas may be pr ovi ded f or use be-
Pr esent mul t i phasi c scr eeni ng pr ogr ams coul d f or e or af t er car di opul monar y t est s, chest
be consi der ed an ext ensi on of t he mass chest x- r ay, mammogr aphy, t her mogr ophy, pop-
x- r ay pr ogr am begun i n t he 1940s. As t he i n- smear , and pr oct oseopy/ si gmoi doscopy . The
ci dence of t uber cul osi s decl i ned, t he usef ul - scr eenee r emoves al l cl ot hi ng t o t he wai st
ness of t hese par t i cul ar scr eeni ng uni t s di mi n- and dons a r adi ol ucent di sposabl e gown.
i shed. However , i n t he 1950s wi t h t he cont r ol
of most acut e di seases, t her e was a r enewed Ant hr opor net r y
i nt er est i n chr oni c di sor der s and mass- scr een-
i ng f or t hem. At t hi s st at i on, t he scr eenee' s hei ght , wei ght ,
Today, not onl y t he medi cal pr of essi on but and t emper at ur e wi l l be measur ed and r e-
al so busi ness and i ndust r y ar e begi nni ng t o cor ded . Var i ous ot her body measur ement s
r eal i ze t he i mpor t ance of pr event i ve medi ci ne . may be t aken at t hi s t i me f or ant hr opomet r i cal
Some exampl es ar e: t he Kai ser Foundat i on, r esear ch pr oj ect s . A ski nf ol d t hi ckness t est
an i ndust r y- f ounded t r ust i n Cal i f or ni a, of f er s ( subscapul ar and t r i ceps) i s per f or med t o det er -
comput er i zed scr eeni ng t o i t s 1 . 5 mi l l i on mem- mi ne t he degr ee of obesi t y . ( See Fi g. 1 .)
ber s ; t he Met r opol i t an Li f e I nsur ance Company
pl ans t o pr ovi de aut omat ed t est s f or over Vi si on
50, 000 empl oyees ; and t he Canner y Wor ker s'
Uni on i n Cal i f or ni a, whi ch can scr een 20, 000 The scr eenee may be exami ned f or vi sual acui t y
wor ker s dur i ng t he t hr ee- mont h canni ng sea- wi t h a Snel l en char t or var i ous t ypes of st er eo-
son, makes mul t i phasi c scr eeni ng avai l abl e scopi c scr eeni ng devi ces may be used t o t est
t o i t s member s i n t hr ee 60- f t l ong t r ai l er s . f or f usi on, acui t y l evel , col or and bi nocul ar
Thi s use of compr ehensi ve scr eeni ng bot h vi si on, t hus el i mi nat i ng t he need f or a Snel l en
i n speci al i zed cl i ni cs and i n mobi l e uni t s i s t he char t . ( See Fi g. 2. )
begi nni ng of pr ovi di ng pr event i ve medi cal Af t er r ecei vi ng pr opar acai n HCI eye dr ops
car e and heal t h educat i on f or al l peopl e. or a si mi l ar medi cat i on as a t opi cal anest het i c,
he i s t est ed f or gl aucoma, i ncr eased i nt r aocul ar
pr essur e, by means of a t onomet er . I f t he el ec-
t r oni c t onomet er i s used, no dr ops ar e needed.
FUNCTI ONAL ANALYSI S He i s pr epar ed f or r et i nal phot ogr aphy wi t h
The f ol l owi ng i s a r esume of t est s t hat coul d phenyl ephr i ne HCI or si mi l ar dr ops i n one eye
be per f or med i n a mul t i phasi c scr eeni ng uni t . 20 mi nut es bef or e t he t est t o di l at e t he pupi l .
Some pr ocedur es ar e mor e sophi st i cat ed t han I f phot ogr aphy i s not used, he may be ex-
ot her s and, t her ef or e, mi ght be mor e di f f i cul t ami ned wi t h an opht hal moscope; however ,
t o adapt t o t hi s si t uat i on. The mor e common t hi s r equi r es t r ai ned per sonnel .
t est s ar e enumer at ed : however , t hi s or der
does not necessar i l y r ef l ect pr oper t est se- Ret i nal Phot o
quence. Equi pment necessar y f or t he var i ous
st at i ons has been i ncl uded wi t h t he appr opr i at e A f undus camer a i s used t o t ake a 35 m m
t est descr i pt i on. phot ogr aph of t he r et i na 20 mi nut es af t er
The scr eenee pr esent s hi s appoi nt ment car d mydr i al i c eye dr ops ar e i nst i l l ed t o det ect any
t o t he vol unt eer or r ecept i oni st . Thi s may be pat hol ogy ( e . g ., di sc changes, r et i nal ar t er i o-
i n t he same ar ea as r egi st r at i on or i t may be i n scl er osi s, hyper t ensi ve angi opat hy, di abet i c
a separ at e l ocat i on . r et i nopat hy, et c.) . Dependi ng on t he t ype and
st r engt h of mydr i at i c dr ops used, t he 20-
mi nut e l i mi t may be exceeded. ( See Fi g . 3.)
Hi st or y
A semi encl osed cubi cl e or pr i vat e r oom i s Hear i ng
desi r abl e f or r egi st r at i on i n or der t o obt ai n
an accur at e medi cal hi st or y . The scr eenee Hear i ng per cept i on i s t est ed t hr ough measur e-
may be r el uct ant t o answer per sonal ques- ment of t one t hr eshol ds . Var i ous f r equenci es
t i ons i n an ar ea wher e ot her s may over hear er e t est ed usi ng i ncr easi ng and decr easi ng
hi m. One sol ut i on t o t hi s pr obl em i s t o have t one vol umes. Audi omet r i c t est i ng may be pr i -
t he scr eenee f i l l out a hi st or y quest i onnai r e mar i l y sel f - admi ni st er ed by means of a speci al
of hom e bef or e hi s appoi nt ment ; however , audi omet er . Qual i t y of t he ear phones i s mor e
t hose who do not r ead or speak Engl i sh f l uent l y i mpor t ant t han t he degr ee of soundpr oof i ng.
and t hose who ar e i l l i t er at e may need hel p i n ( See Fi g. 4.)
answer i ng t hese quest i ons. Dur i ng r et ur n
appoi nt ment s, scr eenees shoul d f i l l out an i n- Gl ucose I ngest i on
t er val medi cal hi st or y .
The scr eenee i s gi ven a 75 gmgl ucose medi um
t o i ngest . Thi s may be di spensed i n bot t l es
or i n a r ef r i ger at ed car bonat ed bever age uni t .
The t i me of admi ni st r at i on i s r ecor ded on t he
appr opr i at e car d. At t he end of one hour ( det er -
Rel ocat abl e Mul t i phasoc Heal t h Scr eeni ng, mi ned by t he scr eeni ng uni t ) , a bl ood sampl e
Resear ch and Gr aduat e Cent er , School of Ar ch- wi l l be dr awn and t est ed f or gl ucose . Test i ng
i t ect ur e, Texas A& MUni ver si t y, Col l ege St a-
t i on, Texas Heal t h Ser vi ces Resear ch, Feder al exact l y on t he pr edet er mi ned hour i s vi t al t o
Heal t h Pr ogr ams Ser vi ces . t hi s t est s accur acy .
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MULTI PHASI C HEALTH SCREENI NG CENTERS

Besi des di abet es, numer ous l at ent condi t i ons

may r esul t i n abnor mal gl ucose l evel s .

Dent al
Thi s st at i on consi st s of a dent al and sof t t i ssue
exami nat i on. Di sposabl e i nst r ument s may be
used . Teet h ar e not cl eaned or f i l l ed i n t he uni t .
( See Fi g . 5.)

Car di opul monar y

Vi t al Si gns The scr eenee l i es down on an ex-
ami ni ng t abl e wher e hi s pul se, r espi r at or y r at e,
and bl ood pr essur e ar e checked and r ecor ded .
Wi t h t he moni t or shown, t emper at ur e may
al so be t aken. Modul ar moni t or i ng equi pment
i s avai l abl e whi ch measur es and di gi t al l y di s-
pl ays vi t al si gns, i ncl udi ng t he r espi r at or y r at e .

El ect r ocar di ogr am An el ect r ocar di ogr am is

t aken t o det ect abnor mal car di ac r hyt hm, con-
duct i on di st ur bances, myocar di al damage,
cor onar y i nsuf f i ci ency, and ot her condi t i ons
whi ch al t er t he nor mal el ect r i cal act i vi t y of t he
hear t . The most common met hod of el ect r o-
car di ogr aphy i n t hi s count r y t oday empl oys Fi g. 5 ( a) Dent al chai r . ( b) Li ght , i nst r ument t abl e, cuspi dor . ( c) St er i l i zer s. ( d) Li ght and cuspi dor .
t wel ve l eads ( I , I I , I I I , aVR, aVL, aVF, V1, V2,
V3, V4, V5, V6) , t aken sequent i al l y . An EKG
may al so be r ecor ded usi ng a si ngl e obl i que
chest el ect r ode. Cady has descr i bed a met hod
by whi ch he det er mi ned t hat t he " or der ed
i mpor t ance of st andar d el ect r ocar di ogr aphi c
l eads wer e l eads V6, V2, and I I I . " An EKG
chai r has been devel oped, but i t i s not yet i n
pr oduct i on. I t consi st s of an el ect r ocar di o-
gr aph and an or di nar y ar t i f i ci al l eat her r e-
cl i ni ng chai r wi t h l i t hi umchl or i de i mpr egnat ed
el ect r odes . ( See Fi g. 6.)

Gr aded Exer ci se Tol er ance EKG A pr el i mi nar y EKG

i s r ecor ded . I f t hi s i s nor mal and t her e i s no
pr i or hi st or y of si gni f i cant myocar di al damage
or i schemi a, an exer ci se EKG may be per -
f or med t o hel p det ect cor onar y i nsuf f i ci ency.
Thi s shoul d r i ot be done wi t hout a physi ci an
pr esent because of compl i cat i ons t hat coul d
ar i se i n per f or mi ng such a t est on ol der pa-
t i ent s and member s of ot her hi gh- r i sk gr oups .

Phonocar di agf am Thi s t est i s done t o r ecor d and

det ect hear t mur mur and abnor mal hear t
sounds . ( See Fi g. 7. ) Fi g. 6 ( a) Moni t or ( B/ P, pul se, t emper at ur e) . ( b) El ect r ocar di ogr aph ( connect abl e t o comput er vi a phone) . ( c) EKG
t abl e. ( d) EKGchai r .
Spi r omet r y The scr eenee i s shown howt o use
t he spi r omet er ( or vi t al omet er ) t o det er mi ne
l ung capaci t y . He exhal es i nt o t he di sposabl e
mout hpi ece of a vi t al omet er t ube or i nt o t he
l ar ge doubl e- l umen cat het er of a spi r omet er .
The amount of exhal ed ai r and t he f l ow r at e
i ndi cat e t he degr ee of r espi r at or y i mpai r ment .
A mor e basi c t est consi st s of measur i ng t he
scr eenee' s chest ci r cumf er ence bef or e and
af t er i nhal at i on . I f i nhal at i on does not i ncr ease Fi g. 7 Phonocar di ogr aph .
t he di mensi on pr oper l y f or age and sex, t her e
i s some degr ee of r espi r at or y i mpai r ment .
( See Fi g. 8. )

%- Ray
Chest A 70- mmpost er i or - ant er i or chest x- r ay
i s per f or med t o det er mi ne pul monar y, car di ac,
or neopl ast i c condi t i ons . Hi gh speed pr oces-
sor s cur r ent l y on t he mar ket can be used t o
devel op f i l ms i n appr oxi mat el y 90 seconds . I f
70- mm x- r ay i s used, a r adi ol ogi st f ami l i ar
wi t h such f i l ms must be used f or t hei r i nt er -
pr et at i on . ( See Fi g . 9.)

Fl at Pl at e of Abdomen Af l at pl at e x- r ay may be
t aken t o vi sual i ze any abdomi nal pat hol ogy.
( See Fi g. 10 . ) Fi g . 8 ( a) Spi r omet er ( por t abl e) . ( h) Spi r omet er ( connect abl e t o comput er ) .
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MULTI PHASI C HEALTH SCREENI NG CENTERS

Fi g. 9 ( a) X- r ay uni t ( 70 mm) . ( b) Devel oper ( 70 mm) .

Fi g. 10 ( a) X- r ay uni t ( 14 by 17 i n . ). ( b) X- r ay casset t e
hol der ( 14 by 17 i n .) . ( c) Devel oper ( r api d pr ocess) .

Fi g. 11 ( a) Panor ami c dent al x- r ay uni t wi t h cont r ol s. ( b) Dent al x- r ay chai r . ( c) Cont r ol s and wal l - mount ed dent al Fi g. 12 Mammogr aphy Uni t .
x- r ay uni t . ( d) Dent al x- r ay uni t ( por t abl e) .

Fi g. 13 ( a) Ther mogr ephi c di spl ay uni t . ( b) Scanni ng

camer a .
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MULTI PHASI C HEALTH SCREENI NG CENTERS

Dent al Bot h panor ami c and api cal f i l ms of t he

ant er i or i nci sor s may be t aken at t hi s st at i on .
( See . Fi g . 11 . )

Mammogr aphy Var i ous x- r ay vi ews ar e t aken

of each br east t o vi sual i ze neopl ast i c condi -
t i ons i n menopausal wom en. ( See Fi g . 12 . )

Ther mogr aphy

Thi s t est i s per f or med on menopausal wom en

t o det er mi ne t he pr esence of br east t umor s,
whi ch ar e shown by an i ncr ease i n t her mal
l evel at t he t umor si t e . I t i s mor e t i me consum- Fi g . 14 ( a) Compact mul t i pl e channel anal yzer . ( b) Bl ood count uni t . ( c) Cent r i f uge .
i ng t han a mammogr am, si nce a " cool i ng
down" per i od of appr oxi mat el y 10 mi nut es
i s r equi r ed ( i n or der t o obt ai n accur at e t her mal
pat t er ns of body heat emi t t ed f r om t he ski n' s
sur f ace) . The scr eenee t hen si t s on a st ool 10
f t f r omt he i nf r a- r ed scanni ng camer a, i n whi ch
t he nat ur al t her mal r adi at i on f r om t he br east
i s r ecor ded and conver t ed t o t her mal pat t er ns
on t he cat hode r ay t ube . These pat t er ns may
be phot ogr aphed. Thr ee t her mogr ams ( one AP
and t wo obl i que) and appr oxi mat el y f i ve i so-
t her ms ( super i mposed pi ct ur es whi ch m ap
Fi g . 15 Mi cr oscope . Fi g . 16 Jet i nj ect or .
t her mal l evel s) may be t aken. ( See Fi g . 13 . )

Labor at or y Test s
Bl ood Bl ood chemi st r y t est s can be per f or med
by means of aut omat ed mul t i channel anal yzer s
usi ng a mi ni mum of sampl e . Techni ques such
as aut omat i c r eagent addi t i on t o sampl e,
synchr onous f l ow t echni ques, r eagent - sampl e
mi xi ng by cent r i f ugal f or ce, t une- cont r ol l ed
i ncubat i ons i n sel f - encl osed pl ast i c packages
cont ai ni ng chemi cal r eagent s, and aut omat i c
pr esent at i on of sampl e pl us r eagent s t o a col or -
i met er or spect r ophot omet er ar e al l avai l abl e
at t he cur r ent st at e of t he ar t . Aut omat i c
sampl e bl anks and r emoval of pr ot ei n or ot her
i nt er f er i ng subst ances by di al ysi s can al so be
accompl i shed . Ther e ar e a l ar ge number and
var i et y of cl i ni cal t est s avai l abl e i n di f f er ent
combi nat i ons and t hese compr i se al most al l
of t he commonl y r equest ed chemi cal par am-
et er s . Al l mul t i channel devi ces cur r ent l y avai l -
abl e possess t he capabi l i t y of i nt er f aci ng t o
comput er s ei t her di r ect l y or i ndi r ect l y ( paper
or magnet i c t ape, dat a car ds, at e . ) and i nde-
pendent l y pr oduce bar char t or pr i nt ed out put .
CBC ( compl et e bl ood count ) and STS ( ser o-
l ogi cal t est f or syphi l i s) shoul d be done on al l
speci mens . Aut omat ed equi pment i s avai l abl e
f or bot h of t hese t est s . The bl ood sampl e may
al so be checked f or t he pr esence of t he r heu-
mat oi d f act or ( i ndi cat i ve of r heumat oi d ar t hr i -
t i s) by means of l at ex f i xat i on t est . ( See Fi g .
14 . ) Fi g . 17 ( a) Exami nat i on l i ght . ( b) Exami nat i on t abl e. ( c) St ool . ( d) Vagi nal specul um. ( e) Exami nat i on t abl e . ( f )
Pr oct oscopes, si gmoi doscopes, bat t er y box f or l i ght .
I l r i nal ySI S The ur i ne speci men i s obt ai ned i n
t he uni t . Toi l et f aci l i t i es may be pr ovi ded near
t he l ab . I t shoul d be t est ed f or col or , speci f i c
gr avi t y, pH, sugar , al bumi n, acet one, and
bact er i a .

Par asi t e Det ect i on Dependi ng on t he needs

of t he scr eeni ng gr oup and t he geogr aphi cal
l ocat i on, t est s t o det ect par asi t es may be
necessar y . Gr oss exami nat i ons of t he f eces
may r eveal t he pr esence of wor ms ; however ,
a mi cr oscopi c exami nat i on may be necessar y
t o det ect par asi t e eggs and smal l wor ms . ( See
Fi g . 1 5 . )

I mmuni zat i on

Space may be pr ovi ded f or admi ni st er i ng i m-

muni zat i ons agai nst communi cabl e di seases Fi g . 18 Achi l l es r ef l ex met er . Fi g . 19 Pr essur e t ol er ance set .
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MULTI PHASI C HEALTH SCREENI NG CENTERS

Fi l l 20 ( a) Sl i de pr oj ect or . ( b) Movi e pr oj ect or , 16 Fi g. 21 ( a) Anenl ar ged dat a col l ect i on sequence f or mul t i pl e heal t h eval uat i on, usabl e i n ei t her a dual aut omobi l e or a
mi n ( c) Tabl e model and f r eest andi ng r ear - scr een smal l t r anspor t abl e uni t ( 12 phase) . ( bl Acompr ehensi ve dat a col l ect i on sequence f or mul t i pl e heal t h eval uat i on, usabl e
pr oj ect or s . i n a compl ex t r anspor t abl e uni t ( 17 phase) .

Such as di pht her i a, measl es, pol i o, smal l pox,

be used t o r ecor d t he t est r esul t s . ( See Fi g .
t et anus, t yphoi d, and whoopi ng cough ( per t us- 18.)
si s) . Those whi ch ar e gi ven depend on i ndi vi d-
ual , ar ea needs and age gr oups . ( See Fi g. 16. ) Pr essur e Tol er ance Thi s t est i s per f or med on t he
Achi l l es t endon t o det er mi ne t he pai n t hr eshol d
of each scr eenee i n or der t o t est f or neur ol og-
Tuber cul i n Ski n Test i ng
i cal damage. ( See Fi g. 19. )
Thi s met hod of t est i ng f or t uber cul osi s i s
bet t er t han a chest x- r ay f or pr el i mi nar y case
Psychol ogi cal Quest i onnai r e
f i ndi ng i n l ow r i sk gr oups . I f t he scr eenee
devel ops a posi t i ve r eact i on af t er 48 hour s, he The scr eenee ei t her f i l l s out a psychol ogi cal
may t hen be gi ven an x- r ay t o conf i r m or r ul e quest i onnai r e or uses pr epunched car ds,
out act i ve pul monar y TB. pl aci ng t hem i n yes or no, t r ue or f al se sl ot s
wher e t he r esul t s may be t abul at ed by com-
Pap Smear put er . Thi s t est may be per f or med t o eval uat e
t he scr eenees ment al pr ocesses ( associ at i on,
Pap smear s t o det ect cer vi cal cancer may be i nt el l i gence, i magi nat i on, emot i on) as wel l as
done on al l mar r i ed women, si ngl e women over hi s r esponses t o var i ous st i mul i . Var i ous t est s
21, t hose who have been pr egnant , and t hose can be used.
under 21 who have pr oper consent . The excep-
t i ons ar e t hose i n t he l ast t r i mest er of pr eg-
nancy. Di sposabl e vagi nal specul a ar e avai l - Heal t h Educat i on
abl e . ( See Fi g. 17d.) Al l scr eenees shoul d r ecei ve speci f i c heal t h
counsel i ng at each scr eeni ng st at i on dur i ng
Pr oct oscopy, Si gmoi doscopy or af t er each t est . I n addi t i on, pr ovi si on coul d
be made f or a speci al heal t h educat i on st at i on
Exami nat i on of t he r ect um and t he si gr noi d at t he end of al l t est i ng pr ocedur es f or ( 1) any
( l ower por t i on of t he descendi ng col on) by f ur t her quest i ons t hat may have ar i sen, ( 2)
means of a l i ght ed i nst r ument ( scope) may be gui dance r egar di ng t he f ol l ow- up pr ocess, and
done t o det ect pol yps or cancer ous l esi ons . ( 3) gener al heal t h i nf or mat i on. Thi s i nst r uct i on
Di sposabl e si gmoi doscopes ar e now avai l abl e coul d be done by per sons such as physi ci ans,
whi ch el i mi nat e t he need f or aut ocl avi ng or r egi st er ed nur ses, heal t h educat or s, or t r ai ned
st er i l i zat i on ( See Fi g. 17f .) vol unt eer s .

Achi l l somet r y Vi sual Ai ds At t hi s same st at i on, pr ovi si on

shoul d be made f or showi ng heal t h r el at ed
Achi l l es Ref l ex Thi s i s a t est t o det ect hypo- sl i des and f i l ms and usi ng a r ear - scr een pr o-
t hyr oi di sm. The scr eenee pl aces one knee on a j ect or . ( See Fi g. 20.)
chai r or st ool wi t h hi s f oot and ankl e ext endi ng
over t he edge. Hi s Achi l l es t endon i s st r uck Li br ar y Asmal l l i br ar y ar ea shoul d be pr ovi ded
wi t h a per cussi on hammer . The r ef l ex act i on i n whi ch pr i nt ed heal t h br ochur es ar e t r ade
( pl ant ar r ef l ex and ext ensi on) i s si mi l ar t o t hat avai l abl e f or t he scr eenees t o t ake home.
of t he knee j er k . I t i s exagger at ed i n upper Heal t h r el at ed magazi nes as wel l as basi c Fi g. 22 Wor k f l ow of uni t wi t h 18 st at i ons . Squar e
mot or neur on di sease and absent i n l ower books on heal t h and hygi ene shoul d be made and di amond symbol s i ndi cat e cr i t i cal i nt er dependence
mot or neur on di sease. A phot omot ogr aph may avai l abl e f or r eadi ng i n t he uni t . bet ween t est s.
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MULTI PHASI C HEALTH SCREENI NG CENTERS

Fi g. 23 Ci r cul at i on pl an ( a) 12 st at i ons, ( b) 18 st at i ons .

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MULTI PHASI C HEALTH SCREENI NG CENTERS

dence wi t h anot her phase. Al l ot her phases Assumed Ti me,

Fi r st Ai d
may be r ear r anged as l ong as t he number of Test mi nut es
Space f or t hi s st at i on shoul d be pr ovi ded f or phases bet ween t hose mar ked as i nvar i abl e
Achi l l eomet r y . . . . . . . . . . . . . . . . . . 4
t he physi ci an or RN t o handl e any emer genci es r emai ns const ant . ( See Fi g. 22. ) Audi omet r y . . . . . . . . . . . . . . . . . . . 5
t hat mi ght ar i se dur i ng t he scr eeni ng pr ocess. Dent al exam. . . . . . . . . . . . . . . . . . . B
Test Dur at i ons Dr essi ng . . . . . . . . . . . . . . . . . . . . . 4
EKG, B/ P, P, R . . . . . . . . . . . . . . . . 8- 8
Basi c Test Sequences Gl ucose . . . . . . . . . . . . . . . . . . . . .
I ndi vi dual t est dur at i ons have been est i mat ed. 2
Basi c pat i ent f l ow char t s ar e r epr esent ed i n Af t er consul t i ng t he USPHS, st af f member s of Heal t h educat i on . . . . . . . . . . . . . . . . 24
Fi g. 21a and b. The i ndi vi dual heal t h eval u- oper at i onal mul t i phasi c scr eeni ng uni t s, nur s- Hei ght , wei ght . . . . . . . . . . . . . . . . . 3- 4
I mmuni zat i on . . . . . . . . . . . . . . . . . . 4
at i on t est s ar e gr ouped accor di ng t o t he i ng per sonnel , and medi cal l i t er at ur e, t he f ol - Medi cal hi st or y . . . . . . . . . . . . . . . . . 24
ease and conveni ence of admi ni st er i ng each l owi ng l i st of assumed t i mes was compi l ed. Mydr i at i c dr ops ( i nst i l l at i on) . . . . . . . . . 2
one, and accor di ng t o equi pment si ze and/ or Act ual t i mes wi l l ver y dependi ng on f act or s Pap smear . . . . . . . . . . . . . . . . . . - . 4- 5
si mi l ar i t y . Funct i onal body syst ems wer e gi ven such as t he t ype of scr eenee, st af f i ng pat t er n, Phonocar di ogr am . . . . . . . . . . . . . . . . 4
onl y secondar y consi der at i on wher e gr oupi ng and t ype of equi pment used . Pr oct oscopy, si gmoi doscopy . . . . . . . . . 12
of t est s was concer ned. Each t est i ng gr oup i s Ent r ance and exi t f or t he scr eenees ar e com- Psychol ogi cal quest i onnai r e . . . . . . . . . 24
r ef er r ed t o as a phase, wi t h di f f er ent number s Regi st r at i on . . . . . . . . . . . . . . . . . . . 4- 5
bi ned, but t he uni t pr ovi des a separ at e per son- Ret i nal phot ogr aphy . . . . .
of phases compr i si ng a compl et e dat a col l ec- . . . . . . . . . 4- 5
nel ent r ance. The heal t h eval uat i on pr ocess Ski nf ol d . . . . . . . . . . . . . . . . . . . . 1- 2
t i on sequence . Test i ng sequence was det er - consi st s of 18 phases . Char act er i st i cs of t hi s Spi r omet r y . . . . . . . . . . . . . . . . . . . . 4
mi ned by conveni ence of ar r angement and by uni t ar e t he separ at e cor r i dor s f or men and Temper at ur e . . . . . . . . . . . . . . . . . . . 1- 4
r equi r ed t i me i nt er val s bet ween phases, e. g ., women and many separ at e scr eeni ng st at i ons Ther mogr aphy . . . . . . . . . . . . . . . . . . 12
20 mi nut es bet ween i nst i l l i ng mydr i at i c dr ops t o use dur i ng t hose t eat s whi ch r equi r e t hei r Tonomet r y . . . . . . . . . . . . . . . . . . . . 2
and t aki ng t he r et i nal phot ogr aph . Phases wear i ng di sposabl e gowns. Af t er t hese t est s Ur i ne speci men . . . . . . . . . . . . . . . . . 2- 4
whi ch ar e heavi l y out l i ned ar e t hose whose Veni punct ur e . . . . . . . . . . . . . . . . . . 4
t hey wi l l under go t he r emai nder of t he t est
posi t i on i n t he dat a col l ect i on sequence may Vi si on . . . . . . . . . . . . . . . . . . . . . . . 7
sequence t oget her . The uni t al so cont ai ns a X- r ay ( chest ) . . . . . . . . . . . . . . . . . .
not be al t er ed because of cr i t i cal i nt er depen- 3- 4
consul t at i on r oom. ( See Fi g. 23.) X- r ay ( dent al ) . . . . . . . . . . . . . . . . . . 1- 2