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DOL Form CM-1159

View OWCP-DCMWC's Form CM-1159 Online 

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:	1240-0023

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