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U.S. Office of Personnel Management Section 3301 of Title 5 United States Code Title 5 CFR 339 For Local Reproduction Only Page 1 of 7 Optional Form 178 April 2012 Formerly SF 78 Previous editions not useable Part A. Ears Include certified audiogram results with the examination package. Right Ear 20 ft. Left Ear 4. Skin and lymph nodes including thyroid gland h. Urinalysis if indicated SP. Gr. Sugar Blood Albumen Casts Pus i. Respiratory tract X-ray if indicated j. Heart size rate rhythm...
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