04. W912LP26Q4004_ATTCH_4_PWS Technical Exhibit 3.pdf

This document is a technical exhibit containing occupational health report forms used by the Iowa Army National Guard for medical examinations.

The document comprises three primary forms: (1) Medical Examination form that categorizes exam types (medical surveillance, respirator evaluation, post-offer pre-placement, transfer, termination/retirement, and special exam) and requires examiners to assess whether examinees are medically qualified to perform essential job functions, with notation of any limitations, accommodations, or temporary conditions; (2) Physical Examination form that documents vital signs, vision testing (far and near, corrected and uncorrected), phoria measurements, and comprehensive physical assessments across multiple body systems including skin, head/neck, chest, lungs, heart, abdomen, hernia, hand grip/pinch strength, spine, range of motion, and extremities, along with optional procedures such as chest x-ray, EKG, blood tests, and spirometry; and (3) Medical History Questionnaire that collects detailed information on general health history, system reviews (cardiovascular, respiratory, dermatological, gastrointestinal, genitourinary, neurological, psychiatric), occupational history, work-related injuries, workers compensation claims, current medical care, personal protective equipment usage, exposure history (asbestos, dust, lead, noise, chemicals, pesticides, radioactive materials, solvents), leisure activities, allergies, current medications, immunizations, and prior diagnostic testing. The forms require examiner signatures and dates and include space for provider explanations of abnormal findings and patient disclosures.