STANDARD FORM 93 (REV. 6-96) BACK. 12. Have you been refused employment or been unable to hold a job or stay in school because of: a. Sensitivity to chemicals, dust, sunlight, etc. b. Inability to perform certain motions. DATE OF LAST MENSTRUAL PERIOD. DATE OF LAST PAP SMEAR DATE OF LAST MAMMOGRAM. YES NO. DON'T KNOW CHECK EACH ITEM.

STANDARD FORM 93(REV. 6/96) (EG) Prescribed by ICMR/GSA FIRMR (41 CFR) 201-9.202-1. Designed using Perform Pro, WHS/DIOR, Apr 97. REPORT OF MEDICAL HISTORY. 1. NAME OF PATIENT (Last, first, middle) 2. IDENTIFICATION NUMBER 7. STATEMENT OF PATIENT’S PRESENT HEALTH AND MEDICATIONS CURRENTLY USED (Use additional pages if …

Standard Forms are used governmentwide for various employment and benefits program purposes. Browse the listing below to download your choice of form (s). On June 26, 2013, the Supreme Court ruled that Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional.

2017年8月17日 · Featured Topics. Per diem rates look-up Allowances for lodging, meal and incidental costs while on official government travel.; Mileage reimbursement rates Reimbursement rates for the use of your own vehicle while on official government travel.

Parents/Guardians may sign this document (SF-93) – a Doctor’s signature is not required for JCLC. Parent/Guardian Signature of Cadet

Welcome to the BUPERS Official Forms Web page. To the left you will find links for NAVPERS and NPPSC forms. Below you will find a important notices and links to official Department of Defense, U.S....

DD FORM 2807-1, AUG 2011 DoD exception to SF 93 approved by ICMR, August 3, 2000. PREVIOUS EDITION IS OBSOLETE. 13.a. Frequent indigestion or heartburn b. Stomach, liver, intestinal trouble, or ulcer 14.a. Adverse reaction to serum, food, insect stings or medicine l. Sexually transmitted disease (syphilis, gonorrhea, chlamydia, genital warts ...

2023年3月28日 · The SF 93 form, also known as the Report of Medical History, is a standard document that serves as an essential record-keeping tool for medical professionals. The purpose of the SF 93 form is to help medical personnel obtain relevant information about a patient’s medical history and previous illnesses.

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