Study Syllabus for Classification of Radiographs of Pneumoconioses

Radiograph Classification

Subset 1

Radiograph Identification

Chest Radiograph Classification form sample
Date of Radiograph

Enter the month, day, year of the radiograph or study date.

Social Security Number

Enter examinee’s full Social Security Number is optional. Last four digits Social Security Number are required, if available and not already recorded.

Name

Enter examinee’s full name. Last, First, and Middle Initial.

Type of Reading

These blocks refer to the qualification of the reader or readers. “A” indicates the reading has been made by an “A Reader”; “B” by a “B Reader”; and “F” for facility or clinical reading. (see appended reprint from the Federal Register for definitions of “A” and “B” readers).

Note: “F” reading is by a physician who has been determined to be qualified to interpret chest radiographs by a licensed clinical health care facility.

Check the box “A”, “B”, or “F” appropriate to your qualifications.

Facility Identification

This number identifies the NIOSH certified facility and radiograph unit conducting the radiographic examination.

Page last reviewed: August 5, 2020