CSO-230.pdf

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RFI - Medical Review Services
Solicitation number
DJM-17-A32-RFI-MED-0001
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CSO-230 Reviewing Medical Officer's Certification of CSO Medical Qualification

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Form CSO-230 Est. 08/15 Page of U.S. Department of Justice United States Marshals Service Reviewing Medical Officer's Certification of CSO Medical Qualification The USMS Form CSO-229 completed by the above-named Examining Physician must be attached to this certification.

CERTIFICATION

I certify as the Reviewing Medical Officer (RMO) that the above-named CSO or CSO Applicant is:

attached documentation request); or 9.0.0.2.20101008.1.734229

CurrentPage:
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PATIENTNAME:
SSN:
DOB:
District:
Circuit:
Years:
ExamDate:
Physician:
:
RMOName:
RMODate:
RMOSignature:
CORName:
CORDate:
CORSignature:

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