It is in the tendency that crew claim caused by seamen's death and disability is substantially increasing in the recent years and we understand the members shall be anxious about this problem.

Especially, crew claim caused by sickness of Filipino crew shall be one of the big problems for the members because, under the standard contract of employment of Filipino seafarer, the shipowners are obliged to pay a large sum of medical expenses and compensation for death and disability caused by illness which was contracted on board the vessel, only by the reason that such illness have been developed on board the vessel even though the seamen had already been suffered from the illness before employment. The best method of preventing this kind of claim is not employing a seaman having a health problem, and the members shall be fully recognized the importance of the Pre- Employment Medical Examination(PEME).

In this association, we have investigated about PEME in the Philippines through our local correspondent in Manila and formulate the comprehensive PEME scheme as Japan P&I PEME Package, which is taken effect on October 1st 2001, which we hereby introduce to the members. In the meantime, we recommend the 6 clinics to perform PEME which are sufficiently equipped and offered an advantageous rates for our PEME Package.

Although we understand that, as the number of test items are many in comparing with the conventional tests required by the regulations, the PEME introduced herewith will result in increasing of the costs for the PEME which the members bear, since we believe that it is highly effective to prevent a huge crew claim before they would occur, we sincerely suggest the members to utilize this scheme.

If you have any question, please contact Crew Claim Section, Claims Department of Japan P&I Club Tokyo(Tel:81-3-3662-7226).

1.Tests carried out under Japan P&I PEME Package
There are 18 tests included in the Package about which we obtained package price fromthe 6 clinics stated in 3.Clinics. Also, the members can additionally select theoptional tests stated 19 to 22 hereunder by the members' decision.

(Japan P&I PEME Package)
1.Complete Physical Examination
2.Psychological Examination
3.Optical test and Visual acuity
4.Dental Examination
5.Urinalysis
6.Chest x-ray
7.Fecalysis
8.Complete blood count (CBC)
9.Blood typing
10.Color vision
11.Audiometry
12.Electrocardiogram (ECG)
13.Fasting blood sugar
14.Hepatitis B Antigen
15.VDRL
16.Pulmonary Function Test (PFT)
17.Erythrocyte Sedimentation Rate (ESR)
18.Blood Chemistry
SGOT(AST) / SGPT(ALT) / Alkaine phosphatase / Bilirubin / Total Protein BUN / Creatinine Cholesterol / Tryglycerides / Uric acid

(Additional Tests)
19.HIV
20.Malaria Test
21.Drug & Alcohol Test
22.Stool Culture

2.Explanation of every tests

(Japan P&I PEME Package)
1.Complete Physical Examination
-interview of patients regarding past medical illness and thorough physicalexamination
2.Psychological Examination
-to assess mental status
3.Optical test and Visual acuity
-ophthalmoscopic examination to determine eye illness and refraction for vision
4.Dental Examination
-mouth and dental disease
5.Urinalysis
-to assess urinary infection, presence of protein for possible nephritic syndrome,spillage of glucose for diabetes mellitus, hematuria for urinary tract infection
6.Chest x
-ray-procedure to visualize common lung pathology like pulmonary tuberculosis andpulmonary nodules. It can also detect heart enlargement.
7.Fecalysis
-stool examination for parasites and occult blood
8.Complete blood count (CBC)
-to detect anemia, leukemia, inflammatory conditions., etc.
9.Blood typing
-ABO blood grouping for transfusion incompatibility
10.Color vision
-to test ability to distinguish colors
11.Audiometry
-hearing test,
12.Electrocardiogram (ECG)
-records heart rate and rhythm, heart enlargement and status of blood supply duringtest
13.Fasting blood sugar
-to detect diabetes mellitus, hypoglycemia
14.Hepatitis B Antigen
- to determine exposure to Hepatitis B virus
15.VDRL
 - blood test for syphilis
16.Pulmonary Function Test (PFT)
- test for restrictive/obstructive lung disease
17.Erythrocyte Sedimentation Rate (ESR)
- non-specific, mainly for inflammatory conditions.
18.Blood Chemistry
A.Liver function test
AST (Aspartate transminase)
/ ALT (Alanine transaminase)
-an enzyme released to the blood when the liver, heart, muscle or brain isinjured. Elevation indicate injury to the liver, heart, muscle or brain.
Alkaine phosphatase
-Elevation indicates bile duct obstruction, liver injury and some cancersBilirubinto determine hepatic obstruction, cirrhosis, etc.Total Protein
-this indicates liver damage, specifically chronic liver disease
B.Kidney function test
BUN (Blood Urea Nitrogen) / Creatinine
- to detect renal function disorder and renal disease
C.Tryglycerides and cholesterol
- to detect risk of coronary artery disease
D.Uric Acid
- blood test indicating gout, leukemia, lymphoma

(Additional Tests)
19.HIV - blood test to diagnose AIDS (acquired immune deficiency syndrome)
20.Malaria Test - blood smear to detect malaria
21.Drug & Alcohol Test
22.Stool Culture - to detect salmonella, required for food handlers

3.Clinic
Since the clinics stated hereunder are sufficiently equipped and vastly experienced ofPEME for seaman, we recommend the members to use them. Also, we have obtained theadvantageous rate of Japan P&I PEME Package from these clinics.Full style of the clinics and the agreed rate are as follows.

1 Angelus Medical Clinic, Inc.
2nd Floor, Aetna Center, 104 Herrera Street, Legaspi Village, Macati City
Tel/Fax:817-0765
2 Maritime Clinic and International Services, Inc.
10th Floor, Times Plaza Building, United Nations Avenue
Corner Taft Avenue, 1000 Ermita Menila
Tel:527-9774 Fax:527-9042
3 Maritime Medical Laboratory Clinic
2nd Floor, Paragon Tower Hotel, 531 A. Flores Street, 1000 Ermita Manila
Tel:526-3809 / 526-3812Fax:526-3816
4 Physicians' Diagnostic Services Center, Inc.
533 United Nations Avenue, 4th Floor Physicians' Tower, Ermita, Manila
Tel:524-0626-28 Fax:522-4223
5 S.M. Lazo Medical Clinic, Inc.
1755 Taft Avenue, Corner J, Nakpil Street, Malate, Manila
Tel:524-1891-98 Fax:524-6325
6 Transnational Medical and Diagnostic Center, Inc.
551 Cabildo Street. Casa Marinero 2 Building, Intramuros, Manila
Tel:338-2144 / 338-0493 / 527-8461Fax:527-6310

Rate of tests

Name of Clinic	Package Prince (18 Tests)	Optional Tests
		HIV	Malaria	Drug & Alc.	Stool Culture
Angelus Medical Clinic	P2,650.00	P400.00	P250.00	P1,400.00	P250.00
Maritime Clinic and International Services	$60.00	$20.00	$3.00	$40.00	$4.00
Maritime Medical Laboratory Clinic	P2,625.00	P400.00	P100,00	P1,250.00	P200,00
Physicians Diagnostic Services Center	P2,625.00	P400.00	P100.00	P1,250.00	P200.00
S.M.Lazo Medical Clinic	P3,135.00	P400,00	P250,00	P2,100.00	P250.00
Transnational Medical & Diagnostic Center	$80.00	$3.00	$0.00	$35.00	$0.00

4.Procedures and other consideration for using Japan P&I PEME Package

(1) Please discuss between the members and the manning agent about use of Japan P&I PEMEPackage, and addition of an additional tests.

(2) If the members refer the seaman to our recommended clinics of Japan P&I PEME Package,please submit to the clinics of the Referral Slip appended to this circular afterfilling up the blank. The clinics, in receipt of the application by this ReferralSlip, acknowledge the seaman as participant of Japan P&I PEME Package and will applythe agreed rate.

(3) It is required about 24 hours until the result of PEME turns out. Therefore, it isnecessary to arrange PEME well before the scheduled date of seaman's departure.

(4) The manning agent or the members pay the clinic's bill.

(5) As guideline for determination of seaman's physical fitness for sea duty, the clinicbasically refer "Medical Rating System for Overseas Contract Workers and Seafarerscirculated by the Department of Health of the Philippines. Nevertheless, the memberscan formulate the own standard to determine physical fitness of the seaman who willjoin the members' vessel and instruct the clinic to follow it.

(6) While some seaman may be declared Fit for Duty but with minor findings, there aremany cases that the owner had to bear the liability for the such pre-existing illnesseven though the illness or the cause of the illness was indicated in the PEMEcertificate. Because, if the company employed such seaman, this fact could be judgedthat the company took the risk which pre-existing illness could be aggravated duringthe term of the contract. Therefore, we suggest the members to be cautious foremployment of such seaman.

(7) AIDS in known as the illness that it will bring the death caused by the other illnesssecondary to AIDS. Recently, there are many cases that the owner had to bear theliability for such illness secondary to AIDS. Therefore, we suggest the members toconduct the HIV screening although it is not included in Japan P&I PEME Package.