fd-944.pdf

FD-944 (Rev. 5-16-2008) 67 Number:

FBI Hazardous Material Response Team - Initial

TO:

FROM: FBI Field Office Examinee: ____________________________________ D.O.B. _________________________ Job Position: ________________________________ Appointment Date: __________________ Time: ________________

Bring all shot records (CDC –731, International Certificate of Vaccination).

CPT Codes Required Core Components (lab) 80061 Required Lipid panel 80053 Required Complete Metabolic Panel 82977, 84550 Required GGT, Uric Acid 81001 Required Urinalysis 82270 Offer Stool for occult blood X 3 82480 Required Plasma cholinesterase, 2 separate draws 82482 Required RBC cholinesterase, 2 separate draws 82955 Required G6PD (may omit if already on record) 83655, 84202 Required Blood lead, ZPP 85025 Required Complete blood count /w differential 86900, 01 Required Blood group & type (If no record) CPT Codes Required Core Components (Screening Tests) 71020 Required Chest x-ray P/A& lateral 86580 Required Mantoux TB test, unless prior hx of conversion 92551 Required Audiometry 93000 Required Resting EKG 12 leads w/ interpretation 94010 Required Pulmonary function test 99172 Required Distant & near visual acuity w/ & w/o corrections 99172 Required Visual fields, strabismus 99172 Required Color vision (if no record) Required Written summary of findings 99385, 96, 97 Required History, PE, vitals (ht, wt, B/P, pulse, resp, temp) FD-899, FD-900 Required Completion of FD-899, FD-900 CPT Codes If Indicated Supplemental Components 84153 Males >40 years Prostate specific antigen 45999 Males > 40 Digital rectal exam 88141 Females If pap > 6 mos offer complete Gyn exam 77057 Females > 40 years Mammography, offer if > 40 years, in conjunction with GYN Breast Exam performed within 1 year, on record 93015 Required at age

40,44,48,50,52,54, & 56 Exercise stress test Bruce protocol

92120 > 40 years Tonometry 93350, 93015 Requires Approval Stress Echo-preferred test-following abnormal screening 93015, 78465, 78478, 78480, A9505, A9502

Requires Approval Thallium stress test-follows abnormal screening

CPT Codes Per Instructions Vaccinations 90632 Update as required Hepatitis A vaccine, basic series 90746 Update as required Hepatitis B vaccine – basic series 90636 Approval required Twinrix 90690 or 90691 Update as required Typhoid (injection Q 2 yrs or oral Q 5) - basic 90707 Update as required MMR (once as adult) 90713 Update as required Inactive polio (IPV) one does as adult 90658 Update as required Influenza, annually 90718 Update as required Tetanus/diphtheria q 10 years 90715 Update as required Tdap- tetanus/diphtheria/pertussis q 10 yrs.

90717 Update as required Yellow fever q 10 years 90733 or 90734 Update as required Meningococcal vaccine – per manufacturers recommended frequency 4120F Screening dose Mefloquine trial, one dose & record reaction 90471 As requested Administration of vaccine – FBI supplied 90581 As available Anthrax, FBI supplied 90675 Approval required Rabies 90749 As available Smallpox