fd-946.pdf
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- Solicitation number
- RFP0215156
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Text version
FD-946 (Rev. 5-16-2008) 67 Number:
FBI Respiratory Protection Program- Baseline Exam for Support ONLY
TO:
FROM: FBI Field Office
Examinee:
D.O.B. Job Position:
Appointment Date: ______________ Time: _____________
CPT Codes Required Core Components 71020 Required Chest x-ray P/A & lateral 94010 Required Pulmonary function test Required Hx, PE, vitals (ht, wt, B/P, pulse, resp., temp.)
FD 900 Required Completion of respiratory questionnaire 99172 Required Distant visual acuity with, w/o correction 99385,86,87 Required Focused physical exam SF 88, block 17, eval a-n
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