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PRE-PLACEMENT PROTOCOL SHEET Name SSN DOB Date Contractor ITEM NUMBER 9881 9816 9589 9877 CLASS TITLE Applications Development Analyst II III IV V. Describe Problem Clinical Findings Near vision Titmus target 5 OU Revised 4/15/09 Exam Indicated Physical exam of the A44 A45 A46 A47 A48 Testing Required Vision retest with near point card A69. U. Near vision Corrected O. U. Review of Basic Pre-Placement Questionnaire Completion of Pre-Placement Results form As Needed Physical Examination...
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