Study Syllabus for Classification of Radiographs of Pneumoconioses

Radiograph Classification

Subset 1

Section 5

4C. Mark All Boxes That Apply form sample

 

This section provides information for identifying the physician interpreting the radiograph.

If appropriate, enter your Social Security number in the block on this line.

Then enter your initials and the date of your reading in the blocks provided. If you choose not to provide your Social Security number, record your last name and address in the blanks provided.

Page last reviewed: August 5, 2020