The file's text, extracted by GovTribe without its formatting.
FD-964 (12/31/2010)
FBI Commercial Driver Exam
To: _____________________________________________________________
From: FBI Field Office _____________________________________________ Examinee: ___________________________________ DOB: _____________
67 Number: _________________ Job Position: _________________________ Bring all shot records (CDC –731, International Certificate of Vaccination)
Appointment Date: _______________________ Time: __________________
| CPT Codes |
| Required |
| Core Components |
| 81001 |
| Required |
| Urinalysis |
| 92551 |
| Required |
| Audiometry |
| 99172 |
| Required |
| Distant & near visual acuity with and without corrections |
| 99172 |
| Required |
| Visual fields, strabismus |
| 99172 |
| Required |
| Color vision |
| 99385,86, 87 |
| Required |
| Written summary of findings |
| 99385,86,897 |
| Required |
| History, Physical Exam, vitals (ht, wt, B/P, pulse, temp) |
| 71020 |
| Needs FBIHQ approval |
| Chest x-ray P/A & lateral |
| 82270 |
| Offer |
| Stool for occult blood X 3 |
| 45999 |
| Offer |
| Digital rectal exam – Males >40 years |
| 90658 |
| Update as needed |
| Influenza, annually |
| 90718 |
| Update as needed |
| Tetanus/diphtheria q 10 years OR |
| 90715 |
| Update as needed |
| Tdap, Tetanus/diphtheria/pertussis q 10 years |
| PROVIDER |
| Please read |
| CFR 391.41 Physical Qualifications for Drivers |
