Get the free Physician’s Statement and Clearance Form - utsa

This form is required for individuals with medical risk factors to obtain clearance from a physician before participating in activities at the UTSA Recreation Center.

How to fill out physicians statement and clearance

How to fill out Physician’s Statement and Clearance Form

1. Obtain the Physician’s Statement and Clearance Form from your healthcare provider or the relevant organization.
2. Fill out your personal information at the top of the form, including your name, date of birth, and contact details.
3. Provide details about your medical history as prompted in the form, including any current medications and past illnesses.
4. Answer any specific questions related to your medical condition that are outlined in the form.
5. Schedule an appointment with your physician to have the form reviewed and completed.
6. During the appointment, discuss your health status and any concerns that need to be addressed on the form.
7. Have your physician sign and date the form after they have completed it.
8. Make a copy of the completed form for your records before submitting it to the relevant organization.

Who needs Physician’s Statement and Clearance Form?

1. Individuals who are participating in sports or physical activity programs that require medical clearance.
2. People who are returning to work or school after an extended illness or injury.
3. Patients undergoing specific medical treatments or surgeries that necessitate a health assessment.
4. Participants in certain recreational activities or competitive events that have strict health guidelines.

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What is Physician’s Statement and Clearance Form?

The Physician’s Statement and Clearance Form is a document used to verify an individual's medical fitness to participate in specific activities, often required by schools, sports organizations, or workplaces.

Who is required to file Physician’s Statement and Clearance Form?

Typically, individuals who are planning to engage in physical activities, sports, or certain job roles that require medical evaluation are required to file the Physician’s Statement and Clearance Form.

How to fill out Physician’s Statement and Clearance Form?

To fill out the Physician’s Statement and Clearance Form, a licensed healthcare provider must complete the sections detailing the individual’s health status, medical history, and any necessary medical advisories related to the activities they wish to participate in.

What is the purpose of Physician’s Statement and Clearance Form?

The purpose of the Physician’s Statement and Clearance Form is to ensure that individuals are medically fit to engage in specific activities, thus preventing health risks and ensuring safety.

What information must be reported on Physician’s Statement and Clearance Form?

The information that must be reported on the Physician’s Statement and Clearance Form typically includes personal identification details, medical history, assessment results, any diagnosed conditions, and the physician's clearance determination.