Of 178 2026

1. Click ‘Get Form’ to open it in the editor.
2. 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 as this certifies your consent for the examination results to be shared.
3. In Part B, the appointing officer will specify the purpose of the examination and provide a brief description of the job requirements. Make sure this section is filled out before proceeding to the medical examination.
4. Part C must be completed by the examining physician. They will assess various health metrics such as height, weight, vision, and hearing. Ensure that they return this part in the provided confidential envelope.
5. Parts D and E are for agency use only. These sections document recommendations from medical officers and human resources regarding employment actions based on your medical examination results.

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