Division of Coal Mine Workers' Compensation (DCMWC)
If you have been approved as a provider of diagnostic testing of miners and former miners in connection with their claims for black lung benefits, you will be mailed an authorization each time a miner selects you to perform testing. You will also be mailed a complete set of reporting forms preprinted with the claimant’s information. If you need additional copies of the forms, you may download them here:
- CM-933 Roentgenographic Interpretation (PDF)
- CM-2907 Report of Ventilatory Study (PFS) (PDF)
- CM-1159 Report of Arterial Blood Gas Test (PDF)
- CM-988 Medical History and Examination for Coal Mine Workers' Pneumoconiosis (PDF)
Instructions for use of the forms may be downloaded here:
Information about test specifications and standards
- Pulmonary Functions specifications and disability tables.
- Arterial blood gas specifications and disability tables.
Important information about digital x-ray imaging
The final rule establishing digital radiography standards for the BLBA program was published on April 17, 2014 and became effective on May 19, 2014. Digital x-rays must conform to all standards found in the final rule. For exact standards and specifications for digital radiography systems and equipment, see Subsection (d) of Appendix A to 20 CFR Part 718. See BLBA Bulletin 14-08, which addresses acceptable standards, format, and storage of digital x-rays.