Asbestos Medical Surveillance Program (AMSP)
Requests must be in writing and forwarded to NAVENVIRHLTHCEN by regular mail, naval message, Telefax: (757) 953-0670 or email amspauthform@nehc.mar.med.navy.mil. An authorized signature is required unless the request is by naval message.
The format used in the following sample letter must be used to request authorization to ship AMSP chest X-rays for B-readings. Paragraph 1 requires information on the quantity of radiograph evaluations. If two exposures are required for an individual, count these two chest films as one. Use the UIC of the MTF shipping the AMSP chest x-ray.
DATE: UIC:
From: (REQUESTING ACTIVITY) (Provide complete mailing address including building number, etc.)
To: Contracting Officer, Navy Environmental Health Center, 620 John Paul Jones Cir Ste 1100 Portsmouth VA 23708-2103
Subj: REQUEST FOR AUTHORITY TO SHIP ASBESTOS X-RAYS FOR B-READINGS
Ref: (a) OPNAVINST 5100.23series Chapter 17
1. Per reference (a), (REQUESTING ACTIVITY) has a total of (QUANTITY) chest radiograph evaluations available for shipping to the designated B-reader. The requested delivery date for films to be returned as completed is 45 days from the date of this request letter.
2. Please forward the order document (DD 1155)
3. Point of contact:
Telephone: __________ DSN: __________ COMM: __________
Telefax: __________ DSN: __________ COMM: __________
E-mail: __________
AUTHORIZED SIGNATURE
Content last reviewed on February 27th, 2009.