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Of 178 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin with Part A, where you will enter your personal information including your name, federal employee number, sex, and birth date. Ensure all details are accurate.
- Indicate if you have any medical disorders that may affect your job performance. If yes, provide a detailed explanation for the examining physician.
- Complete your contact information including address, email, and phone numbers. Finally, sign and date the form to certify the accuracy of your information.
- In Part B, the appointing officer will fill out details regarding the purpose of the examination and position requirements. Ensure they complete this section before your medical exam.
- Part C is for the examining physician to document findings. Make sure they return this part in the provided confidential envelope.
- Parts D and E are completed by agency medical and human resources officers respectively after reviewing the examination results.
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