CSO-012a.pdf

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RFI - Medical Review Services
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DJM-17-A32-RFI-MED-0001
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CSO-012a Court Security Officer's Medical Qualification Reevaluation Decision

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Form CSO-012A Est. 08/15 Page of Court Security Officer's Medical Qualification Reevaluation Decision U.S. Department of Justice United States Marshals Service

REVIEWING MEDICAL OFFICER (RMO) CERTIFICATION

Based on the company's personal observation and the information provided herein, it is the company's opinion that this individual meets all of the Court Security Officer medical standards.

I agree / disagree with the attending physician's recommendation regarding the individual's ability to safely perform Court Security Officer duties.

Additional documentation regarding my decision is attached/ not attached.

CONTRACTOR REPRESENTATIVE CERTIFICATION

Based on the company's personal observation and the information provided herein, it is the company's opinion that this individual meets all of the Court Security Officer medical standards.

I agree / disagree with the attending physician's recommendation regarding the individual's ability to safely perform Court Security Officer duties.

Additional documentation regarding my decision is attached/ not attached.

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