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Cg 5447-2026

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The document is a comprehensive form for the Occupational Medical Surveillance Examination Program (OMSEP), detailing patient information, occupational and family health history, social habits, personal health history, and medical officer's evaluations. It aims to assess potential health risks related to occupational exposures and ensure compliance with privacy regulations.

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Click ‘Get Form’ to open the cg 5447 in the editor.
Begin by filling in your personal information in Section I, including your last name, first name, middle initial, grade/rate/rank, and SSN. Ensure accuracy as this data is crucial for identification.
Complete your home address and contact details. This includes your home phone and work/duty phone numbers. Make sure to include the correct unit name and location.
In Section II, provide details about your occupational history. Answer questions regarding exposure to hazards and protective equipment usage honestly.
Proceed to Section III and IV to disclose family health history and personal health symptoms. Be thorough in your responses for a comprehensive assessment.
Finally, review all entries for accuracy before signing at the bottom of the form. Use our platform’s features to save or print your completed document easily.

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Versions	Form popularity	Fillable & printable
2003	4.9 Satisfied (38 Votes)

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