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Form OF-178

Certificate of Medical Examination

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Form reference

Before you begin.

Use these notes as a starting point. Check the issuing agency’s current form and instructions for your client’s situation.

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Gather Required Medical Information

Before you begin filling out Form OF-178, make sure to have all necessary medical documentation and personal information handy. This includes your full legal name, Federal Employee Number if applicable, birth date, and any medical history details required for the examination. Being prepared will ensure a smooth and efficient form-filling process.

Details worth checking

Incorrect Name Format

A common error is entering the full name without the middle initial, or in the wrong order, in Part A of Form OF-178. This can lead to misidentification and processing delays. It’s crucial to follow the format: Last Name, First Name, Middle Initial.

Missing Federal Employee Number

Federal employees sometimes omit their Federal Employee Number in Part A, which is essential for confirming employment status. Missing this number can hinder verification processes and delay form approval.

Unselected Sex

Neglecting to select 'Male' or 'Female' in Part A is a prevalent mistake. This crucial demographic data is needed for proper identification and medical record accuracy.

Improper Birth Date Format

Entering the birth date in the wrong format can lead to illegibility or misinterpretation of the form. The correct format is MM/DD/YYYY, and using another format can cause confusion.

Lack of Explanation for Medical Disorders

If you answer 'Yes' to having medical disorders, failing to provide an explanation can result in an incomplete assessment of your medical fitness. This explanation is crucial for understanding your health status.

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