Attach_15_Medical_Forms_and_Screening_Information.pdf
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- HSFE20-15-R-0012
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Attachment 15
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Medical Support Services
Center for Domestic Preparedness (CDP)
Anniston, AL
Attachment 15
Medical Forms and Screening Information
CDP-TE-0045 Center for Domestic Preparedness (CDP) 01/23/2013 Medical Forms Information Sheet
Department of Homeland Security
Federal Emergency Management Agency
Center for Domestic Preparedness Medical Forms Information Sheet
IMPORTANT INFORMATION REGARDING
MEDICAL FORMS
PLEASE READ CAREFULLY
You are required to print, fill out, and sign the Authorization to Release Privileged
Medical Record Information Form provided in your welcome packet. Your supervisor or a coworker may sign the form to witness your signature; a witness signature is required.
You are required to fill out the Respiratory Medical Evaluation Questionnaire or the Health Information Form provided in your welcome packet.
You must bring the printed original of all of the above mentioned forms to the
CDP. CDP staff will collect your completed forms upon arrival at the CDP during inprocessing.
To protect your privacy, do not fax or e-mail any medical forms.
If you have any questions concerning these documents, or the information above, please call
Student Services at 256-847-2132/2072 or toll free at 866-213-9551/9553
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