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PHYSICAL EXAMINATION FORM Child's Name: Address Last: First: Name of Parent or Guardian Allergies Asthma Chicken Pox Diabetes Measles (Rubella) Meningitis Mono Mumps Scarlet Fever Strep Name of Physician

How to fill out physical examination form

How to fill out a physical examination form:

1. Start by carefully reading through the form: Before filling out the physical examination form, make sure to read all the instructions and requirements mentioned on the form. Familiarize yourself with the sections and any specific details that need to be provided.
2. Provide personal information: Begin by filling in your personal information accurately. This typically includes your full name, date of birth, contact information, and any other details required by the form.
3. Medical history: Complete the section on medical history. This may include questions about previous illnesses, surgeries, medical conditions, allergies, medications, and vaccinations. Be honest and provide as much detail as possible in this section.
4. Family medical history: Some forms may have a section dedicated to family medical history. If applicable, provide details about any significant illnesses or medical conditions that your close family members have experienced.
5. Lifestyle habits: Certain forms may ask about your lifestyle habits such as smoking, alcohol consumption, exercise routine, and diet. Answer these questions truthfully to provide a clear picture of your overall health status.
6. Current medications: If you are currently taking any medications, provide the necessary details in this section. Include the name of the medication, dosage, frequency, and reason for taking it.
7. Additional tests or screenings: The physical examination form may require you to undergo additional tests or screenings, such as blood tests, X-rays, or specific medical evaluations. Follow the instructions provided and arrange for these tests if necessary.
8. Signature and date: Once you have completed all the required sections of the form, sign and date it. By signing, you acknowledge that the information provided is accurate to the best of your knowledge.

Who needs a physical examination form?

A physical examination form may be required for various purposes and individuals, including:

1. Students: Many schools, colleges, and universities require students to complete a physical examination form before enrolling or participating in certain activities. This helps ensure the individual's overall health and prevents the spread of contagious diseases within educational institutions.
2. Employment: Some companies and organizations, particularly those in physically demanding or high-risk industries, may require employees to undergo a physical examination as part of the hiring process or periodically to assess their fitness for work.
3. Sports participation: Athletes participating in competitive sports often need to complete a physical examination form to ensure they are physically fit and capable of engaging in the sport safely. This helps identify any underlying conditions or limitations that may affect their performance or increase the risk of injuries.
4. Immigration or visas: Physical examination forms are sometimes required as part of the immigration or visa application process. This helps evaluate the health status of individuals seeking to enter a new country and prevent the spread of infectious diseases.
5. Insurance purposes: Insurance companies may request individuals to complete a physical examination form before providing coverage. This helps assess the overall health and potential risks associated with providing insurance coverage.

It is important to note that the specific requirements for a physical examination form may vary depending on the purpose and organization requesting it. It is recommended to follow the instructions provided by the respective institution or entity to ensure accurate and timely completion of the form.

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What is physical examination form?

Physical examination form is a document used to record the results of a medical examination.

Who is required to file physical examination form?

Employees in certain industries or occupations may be required to file a physical examination form.

How to fill out physical examination form?

The form must be filled out by a licensed healthcare provider after conducting a physical examination of the individual.

What is the purpose of physical examination form?

The purpose of the physical examination form is to assess the health and fitness of an individual for specific job roles or activities.

What information must be reported on physical examination form?

The form typically includes the individual's medical history, vital signs, and results of physical tests.