OPM · Official form

OF 178 Certificate of Medical Examination

Optional Form 178 documents the medical examination required for certain federal positions. The agency, the applicant or employee, and the examining physician each complete their own part of the form.

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What is OF 178?

OF 178, Certificate of Medical Examination, is the OPM form federal agencies use when a position has established medical standards or physical requirements, such as law enforcement, firefighting, or jobs requiring arduous duty. It records the results of a pre-employment or periodic medical examination so the agency can decide whether the person meets the requirements of the position.

The form is split into parts: the agency describes the position and its demands, the applicant or employee provides a medical history, and the examining physician records findings from the physical examination. Because it contains medical information, agencies must handle the completed form under the privacy rules that apply to employee medical records.

Who files OF 178?

Applicants for federal positions that have medical standards or physical requirements
Current federal employees who need a periodic or fitness-for-duty examination for their position
Examining physicians, who complete the clinical portions and report their findings
Agency HR or occupational health staff, who initiate the form and describe the position's demands

How to fill out OF 178

The employing agency completes its section first, describing the position, its physical demands, and the environmental factors involved.
Fill in your identifying information and answer the medical history questions honestly and completely.
Take the form to the examination; the physician completes the clinical sections and records the findings.
Make sure the physician signs and dates the certificate before you leave the appointment.
Return the completed form to the requesting agency's HR or occupational health office by the deadline they gave you; it does not go to OPM.

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These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to OPM.

Page 2 18 fields

Your name (last, first, middle initial).

Your Federal Employee Number.

Select whether you are male or female.

Your birth date (month, day, year) or select it from the dropdown.

Select yes if you have a medical disorder or pysical impairment that may interfere with your duties. Select no if you do not.

Describe your medical disorder or physical impairment here.

Your full street address (including city, state, and zip code).

Your E-mail address.

Your 10-digit telephone number.

The applicant or employee name here to consent.

The date (month, day, year) the applicant signed this form or select the date from the dropdown.

Select whether the purpose of this exam is pre-placement or other.

If the purpose of the exam is other, please specify.

The position title, series, and grade.

A brief position description.

The applicant/employee's name here (bottom of page two). This information will autofill at the bottom of pages three through seven.

The last four digits of the applicant/employee's Social Security Number here (bottom of page two). This information will autofill at the

The date this form was filled out here (bottom of page two). This information will autofill at the bottom of pages three through seven.

Page 3 107 fields

Page 4 27 fields

The feet number of employee/applicant's height. Example: Enter "5" for 5 feet 10 inches tall.

The inches number of employee/applicant's height. Example: Enter "10" for 5 feet 10 inches tall.

The employee/applicant's weight in pounds.

The denominator of the left eye without corrective lenses. 20 over ##.

The denominator of the right eye without corrective lenses. 20 over ##.

The denominator of the right eye with corrective lenses. 20 over ##.

The denominator of the left eye with corrective lenses. 20 over ##.

The type of test used to test depth perception.

The seconds of arc.

The number the applicant got correct.

The number tested.

Select whether the test results are normal or abnormal.

The number of degrees for the right nasal.

The number of degrees for the left nasal.

The number of degrees for the right temporal.

The number of degrees for the left temporal.

The beginning inches measurement for the left eye without corrective lenses.

The ending inches measurement for the left eye without corrective lenses.

The beginning inches measurement for the left eye with corrective lenses.

The ending inches measurement for the left eye with corrective lenses.

The beginning inches measurement for the right eye without corrective lenses.

The ending inches measurement for the right eye without corrective lenses.

The beginning inches measurement for the right eye with corrective lenses.

The ending inches measurement for the right eye with corrective lenses.

Select yes if color vision is normal by Ishihara or other color plate test. Select no if it is not.

If color vision is not normal, select yes if the applicant can pass the latern test. Select no if not.

Select yes if the applicant can see red/gree/yellow. Select no if not.

Page 5 22 fields

The number for the right ear from 20 feet.

The number for the left ear from 20 feet.

Describe any abnormalities or malfunctions with speech. If normal, indicate so.

Describe any abnormalities of the eyes, ears, nose, and throat. If normal, indicate so.

Describe any abnormalities of the abdomen. If normal, indicate so.

Describe any abnormalities of the head and back, including face, hair, and scalp. If normal, indicate so.

Describe any abnormalities of the peripheral blood vessels. If normal, indicate so.

Describe any abnormalities with the extremities, including issues with strength and range of motion. If normal, indicate so.

Describe any abnormalities with the skin and lymph nodes, including the thyroid gland. If normal, indicate so.

Describe any abnormalities of the back. If normal, indicate so.

Describe any neurological and mental health abnormalities, including issues with reflexes and sensation. If normal, indicate so.

Describe any abnormalities with the urinalysis. If normal, indicate so.

Describe any abnormalities with the respiratory tract. If normal, indicate so.

Describe any abnormalities with the heart, including issues with size, rate, rhythm, and function. If normal, indicate so.

The sugar results of the urinalysis.

The blood albumen results of the urinalysis.

The SP. Gr results of the urinalysis.

The casts results of the urinalysis.

The pus results of the urinalysis.

The applicant's EKG results, including any abnormalities.

The applicant's blood pressure.

The applicant's pulse.

Page 6 7 fields

Select whether or not the applicant has limiting conditions for this job.

Describe any medical findings that would limit the applicant's ability to perform this job. If there are no limitations, please indicate so.

The examining physician's name.

The examining physician's address, including street, city, state, and zip code.

The examining physician's phone number.

The examining physician's e-mail address.

The date the examining physician digitally signed this form or select it from the dropdown.

Page 7 15 fields

Select whether the applicate is hired/retained, non-selected for appointment, or action taken to separate.

The agency medical officer's name.

The agency medical officer's e-mail address.

The agency medical officer's address, including street, city, state, and zip code.

The agency medical officer's phone number.

The agency HR officer's name.

The agency HR officer's address, including street, city, state, and zip code.

The agency HR officer's e-mail address.

The agency HR officer's phone number.

The date the agency medical officer digitally signed this form or select it from the dropdown.

The date the agency HR officer digitally signed this form or select it from the dropdown.

Briefly explain why the employee/applicant is medically qualified.

Briefly explain why the employee/applicant is medically qualified if restrictions are accommodated, and list what those restrictions are.

Briefly explain why the employee/applicant is medically disqualified.

Select whether the employee/applicant is medically qualified, medically qualified with accommodations, or medically disqualified.

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Frequently asked questions

Do all federal jobs require an OF 178?

No. Only positions with established medical standards or physical requirements use it, such as law enforcement officers, firefighters, and other physically demanding occupations. Most federal office positions do not require a medical examination.

Who pays for the examination?

That depends on the agency and the situation. Agencies often arrange and pay for required examinations, but confirm with the HR office that sent you the form before scheduling anything.

OF 178 Certificate of Medical Examination

What is OF 178?

Who files OF 178?

How to fill out OF 178

Quick fill OF 178 on this page

Frequently asked questions

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