Sample Spiro Results Notification

Attachment 18_Sample Spiro Results Notification Letter BLANK.PDF

National Coal Workers' Health Surveillance Program (CWHSP)

Sample Spiro Results Notification

OMB: 0920-0020

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NAME

Dear NAME
The National Institute for Occupational Safety and Health (NIOSH) in Morgantown, West Virginia, administers
the Coal Workers' Health Surveillance Program (CWHSP) which is a congressionally-mandated medical
examination surveillance program for monitoring the health of coal miners. The CWHSP was originally
authorized under the 1969 Federal Coal Mine Health and Safety Act and is currently authorized under the 1977
Federal Mine Safety and Health Act and its subsequent amendments (the Act). You had a coal miner health
examination conducted under the CWHSP on DATE at CLINIC NAME in CITY, STATE.
Enclosed are the results of your spirometry test performed during that time. (If you had a chest radiograph taken
as part of this national health surveillance program, then you will receive those results in a separate letter.)
The results of your baseline spirometry testing conducted on DATE were INTERPRETATION. The actual
values from your tests are enclosed with this letter. You should provide this information to your personal
physician, so that it may be added to your medical records. Any abnormal test results should not be considered
a diagnosis of disease; that determination can only be made by your personal physician following a complete
medical evaluation.
Explanation of Test Results
The purpose of the spirometry test, which you performed DATE, is to determine how your lung function
compares to expected normal lung function. The test includes measurements of the forced vital capacity (FVC)
(this is the maximal or total amount of air you can forcefully breathe out after taking a deep breath) and the 1 second forced expiratory volume (FEV1) (this is the amount of air that you can breathe out

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in the first second of exhaling), and the calculation of the ratio of FEV1 to FVC. In the enclosed report entitled,
'Report of Spirometry Findings,' your test results are compared to predicted values for a healthy, non - smoking
person of the same age, height, sex, and race. Graphs of your breathing tests appear on the second page.

If you have any questions or concerns about the CWHSP, please contact us at the address or telephone number
listed above or at our toll-free number (1-888-480-4042).
Sincerely yours,

Laura E. Reynolds, MPH, BSN, RN, COHN-S
Team Leader, Coal Workers' Health Surveillance Program
Surveillance Branch
Respiratory Health Division

Enclosure(s)

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