Agency:

OWCP-DCMWC

Title:

CM-1159, Report of Arterial Blood Gas Study

Form Description:

CM-1159, Report of Arterial Blood Gas Study: After a coal miner applies for black lung benefits, a complete pulmonary evaluation is authorized in order to determine if the claimant is totally disabled by pneumoconiosis. The arterial blood gas study is one part of the evaluation. The CM-1159 is completed by the physician.

OMB Control Number:

1215-0090

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