Medical Surveillance Contract Service List.pdf

CONTRACT SERVICES (Including but not limited to):

EXAM TYPES:

Yearly Physical Exam CDL Certification Crane Operator Certification Fit-for-Duty

MEDICAL SERVICES:

Blood, Cadmium Blood, CBC & CMP Blood, Cholinesterase Blood, Plasma, Chromium Blood, Lead & ZPP Blood, Manganese CDL Physical/Form Crane Operator Form (Appendix D) Diver Form (Appendix E)

EKG

ENT

Examination, Face-to-Face w/Provider x (20 min.)

Examination, Med/Occ Health History Liver Function Test OSHA - Asbestos Questionnaire OSHA - Respirator Questionnaire Pulmonary Function Test Respirator Medical Certificate Urinalysis, Dipstick - Only Urine, Arsenic Urine, Cadmium Urine, Chromium USCG Form (CG-719-K) Vision - near/distant X-Ray- PA & Lateral

ADDITIONAL FEES/SERVICES:

Aresenic Random Urine Arsenic 24 Hour Urine Fractionation Audiogram, Retest(s)

BUN

Comprehensive Chemistry Panel Glycohemoglobulin-A1c Heavy Metal- Lead, Arsenic, & Mercury Heavy Metal Urine Lipid Panel

ADDITIONAL FEES/SERVICES (Cont):

Physical Capacity Test Random Urine, Magnesium Random Urine, Mercury Respiratory Fit Testing (upon request) Urinalysis, Microscopic

REQUIRED DOCUMENTATION:

Report to Employer CDL Physical/Form Crane Operator Form (Appendix D) EKG [Print out] Examination, Med/Occ Health History Laboratory Results/Reports Letter, Medical Opinion - Arsenic Letter, Medical Opinion - Cadmium Letter, Medical Opinion - CrVI Letter, Medical Opinion - Lead Letter, Medical Opinion - Manganese OSHA - Asbestos Questionnaire OSHA - Respirator Questionnaire Pulmonary Function [Print out] USCG Form (CG-719-K) Vision - [Print out, when not included w/Hx] X-ray Interpretation Report

MEDICAL EMPLOYABILITY:

Psychiatrist Psychologist Psychologist Court Testimony Worker’s Compensation Specialist Orthopedic IME Psychiatry IME Internal Medicine Specialist Gastroenterologist Cardiologist Independent Medical Exam Allergist Neurologist