attmt__9_Non-Psych_Medical_Consultation_Request_Form.pdf
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- Attached to
- Pre-employment and Employee Medical Services
- Solicitation number
- HSBP1013R0033
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Attachment 9 Non-Psych Medical Consultation Request Form
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U.S. Department of Homeland Security
[Requesting Office] [Street Address, Room/Suite] [Requesting Office City, State, Zip Code]
U.S. Customs and Border Protection
[Date]
[Contractor Name] Attention: [Contractor Point of Contact] [Contractor Street Address] [Contractor City, State, Zip Code]
Dear [Point of Contact]:
Enclosed is additional medical information for:
[Candidate / Employee] [Contractor] ID Position Medical ID [Name] [Contractor ID #] [Position] [CBP ID #]
***Please note:
[Additional information to the Contractor regarding CBP’s request]
Sincerely, [COR]
[Office]
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