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� <br /> ' NOW G�r� Occupat+onal Healrh Serv�cu <br /> ' PMY$ICIAN'S 4VRZTTEN dP'INIQN <br /> AsbestosfRespiratory Protectior� <br /> � <br /> baTe� `� �"� �� <br /> Frotn: NOW Care Medical Cente+rs, Inc <br /> ' �,�", <br /> EQrnpany:_ L.-� � �rQ��� ,_ <br /> � Patient name: �C � . <br /> � SoCi41 $eCuri#y n�Mber: u�✓��` ~ ��� <br /> In accordance with the requ+rements af USMA ,�sbest�s 5'tandards t�nder 29 GFI� <br /> ' 1926.1141, the exQmining phys�ciar, wi�1 provide the employe� with a written apinian, <br /> whic� shalf contnin fhe �ollowinq: <br /> � <br /> This is to tertify, that x have exarnined the ab�ave r�nm�:�d patient and <br /> deterrnined an this date �'��-� "�,��a�nd in �cto�donc �wifh ihe `'• <br /> � O5�HA Standord 29, CFR 1�26.11�� the individual rct�,y ( G�rmaY t�at ( ) use u <br /> r�pirfltory device while per#orttt�ttg hislhe�r em�loyrrient 5�r'Vi�eS. <br /> , `C' results of rct examinat�on hov� nor ��'�+avc �( } dQtee�ted t� medica! <br /> he � <br /> tonditian w�ticFti wauld pi�ce the employ�e at an (ntr�t�sed risk of t�tateriaf <br /> , health impa�rment from exposure to nsb�stox; a►,d �n ���o�da�►ce w�#� asHa <br /> : require�ner�ts, z have +nformed the above named individ�al af the results ot <br /> � . his/h�r expasure to asbestos, <br /> Re.comtn¢ndations: S� 5'''`�-�Lt,. , <br /> 1 <br /> I rautinely ndvise all scre�ned p�tie+nts that c�ny d, gree c�f st�oking mny t�ave a. <br /> � seriaus ar�d cdverse syne�gistic relatiQnship with Qsbestos. - <br /> (company} artd each appl+cant m+�s1' determ�ne whether s�okers <br /> tshoutd be hired for asbes�os � position. , <br /> Th��com�lei�e medical writ vp;nion n t�e �above m d inci��vidu4t wi11 be <br /> forwarded to the emplo r pe�d4n inai inte+-pr to#io of any ariditianal med�cal <br /> ' dafic required by �'he m �c 1-ex �ne�. ' <br /> ' S�GN�O� <br /> � C'��• <br /> {�xotnin+n�Pt�ys+cian) <br /> � <br />