OSHA's Respiratory Protection standard (29 CFR 1910.134) requires every employer whose workers use respirators — whether required by another standard or voluntarily worn — to establish and maintain a written Respiratory Protection Program. The program must be site-specific, administered by a suitably trained program administrator, and updated as workplace conditions change. Mandatory elements include: (1) hazard assessment and respirator selection; (2) medical evaluation of each user before fit testing and use, typically via the OSHA Appendix C Respirator Medical Evaluation Questionnaire reviewed by a Physician or Other Licensed Healthcare Professional (PLHCP); (3) qualitative or quantitative fit testing at initial assignment, whenever a new model is used, and at least annually; (4) training on respirator use, limitations, maintenance, and emergency procedures; (5) cleaning, inspection, repair, storage; (6) program evaluation; and (7) recordkeeping. For occupational-health clinics, the medical evaluation and fit-testing components are the recurring revenue and clinical workflow — but it is critical to understand that the clinic provides only two of seven program elements; the employer remains accountable for the rest.