BP / D. Beryllium E. Aluminum F. Coal / Comprehensive Occupational Resources LLC / CORE LLC / / /
Event
Product Issues / /
IndustryTerm
prolonged insurance negotiations / hazardous chemicals / prospective employer / health-related products / law-enforcement investigations / hazardous airborne chemicals / insurance carriers / insurance / gas masks / health insurance plan information / chemicals / /
MedicalCondition
D. Claustrophobia / A. Eye irritation B. Skin allergies / indigestion / feet B. Back pain C. Difficulty / job M. Chest pain / seizures / H. Coughing / Shortness of breath / C. Allergic reactions / lung diseases / F. Heart arrhythmia / K. Wheezing L. Wheezing / I. Coughing / G. High blood pressure H. Any / B. Diabetes / lung problems B. Heart Trouble C. Blood pressure D. Seizures / pain / back injury / injury / job G. Coughing / A. Seizures / K. Any chest injuries / A. Heart attack B. Stroke C. Angina D. Heart failure E. Swelling / J. Coughing / dizziness / sugar disease / /
MedicalTreatment
surgeries / /
Organization
Occupational Safety and Health Administration / /
Person
OSHA RESPIRATOR / /
Position
Privacy Official / Medical Review Officer / supervisor / personal physician / Physician / Major / receptionist / representative / C. Anxiety D. General / /
BR_Respirator_Questionaire(c1).pdf Patient Registration - Consent Form Please fill-out form completely. See the back page of this form for Notice of Privacy Practices. Print Please Print Please