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HEALTH SERVICES POLICY & PROCEDURE MANUAL North Carolina Department Of Public Safety Prison SECTION: Assessment of Patient POLICY # A 2 PAGE 1 of 19 SUBJECT: Intake Physical Exam and PLEAT System

How to fill out intake physical exam and

How to fill out an intake physical exam:

1. Start by providing your personal information such as name, address, date of birth, and contact details.
2. Fill out your medical history, including any pre-existing conditions, allergies, or surgeries you have had in the past.
3. Provide information about your family medical history, such as any hereditary diseases or conditions that may run in your family.
4. Answer questions regarding your lifestyle habits, such as smoking, alcohol consumption, exercise routine, and diet.
5. List any medications or supplements you are currently taking, including the dosage and frequency.
6. Fill out a comprehensive review of systems, which includes questions about your overall health, including any symptoms you may be experiencing in different body systems.
7. Sign and date the intake physical exam form to confirm that all the information provided is accurate and complete.

Who needs an intake physical exam:

1. Individuals who are applying for a new job or starting school may be required to undergo an intake physical exam as a part of the enrollment process or to ensure they can meet the physical demands of the job.
2. Patients who are seeking healthcare services from a new provider may be asked to complete an intake physical exam form to provide the physician with a comprehensive understanding of their medical history and current health status.
3. Insurance companies may request an intake physical exam to assess the overall health and risk factors of individuals before providing coverage or setting premiums for life or health insurance policies.
4. Individuals who have been involved in an accident or have sustained an injury may need an intake physical exam to assess the extent of their injuries and determine appropriate medical treatment.
5. Those planning to participate in certain sports or athletic activities may be required to undergo an intake physical exam to ensure they are physically fit and able to safely engage in the activity.

Remember, the necessity of an intake physical exam may vary depending on specific circumstances, so it's best to consult with the requesting party or your healthcare provider for more information.

For pdfFiller’s FAQs

What is intake physical exam?

Intake physical exam is a medical examination conducted to assess the health status of an individual upon their entry into a certain organization or program.

Who is required to file intake physical exam?

Individuals who are entering a new job, school, sports team, or any other program that requires a physical examination are required to file an intake physical exam.

How to fill out intake physical exam?

To fill out an intake physical exam, one must provide accurate personal and medical information, answer any relevant questions truthfully, and follow any specific instructions provided by the organization or provider conducting the exam.

What is the purpose of intake physical exam?

The purpose of intake physical exam is to ensure that individuals are physically fit and healthy to participate in a specific program or activity, as well as to identify any underlying health issues that may require treatment or monitoring.

What information must be reported on intake physical exam?

Information that must be reported on intake physical exam includes medical history, current medications, allergies, previous surgeries or illnesses, family history of diseases, and any symptoms or concerns the individual may have.

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