fd-951.pdf
PDF 60 KB Posted
- Solicitation number
- RFP0215156
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FORM
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Text version
FD-951 (Rev. 5-16-2008) 67 Number:____________________
TO: __________________________________________
FROM: FBI LEGAT Medical Program HQ: _________________________________________
Examinee: ___________________________ D.O.B. _____________
Employee's Name: _______________________ Employee's Job Position: _____________________
Bring all shot records (CDC 731, International Certificate of Vaccination)
Appointment Date: __________ Time: ___________ Type of Exam:____________________
99381 Required History, PE, document race
Required Height, weight, heart rate
Required Written summary from MD re: abnormalities
83655 9 mos to 6 yrs Blood lead level
86900, 01 Blood group & type
85660 9 mos to 1 yr Sickle cell trait if black or Mediterranean descent
Required Head circumference
Requested Vaccines per assigned country
| personnel file number: |
| to: |
| from: |
| examinee: |
| DOB: |
| Employee's Name: |
| Employee's job position: |
| appointment date: |
| time: |
| type of exam: |
File details come from the government source that posted it. Updated .