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Form 75.880 Rev. 05/00, 09/05, 08/07,04/10 OFFICE OF HEALTH SERVICES & WELLNESS Home Room Teacher Physical Examination Record (To be filled out only by a physician) Grade Name Address Phone N o. Date

How to fill out student physical examination form

How to fill out student physical examination form:

1. Start by providing your personal information, such as your name, date of birth, and contact details.
2. Indicate your school or educational institution, along with your grade or level.
3. Fill in the date of the examination and the name of the examining physician or healthcare provider.
4. Provide your medical history, including any existing conditions, allergies, or medications you are currently taking.
5. Answer any questions about your family history of medical conditions, such as diabetes, heart disease, or cancer.
6. Complete the section regarding immunizations or vaccinations you have received.
7. If necessary, attach any additional medical documents or reports that are required.
8. Sign and date the form to certify that the information provided is true and accurate.

Who needs a student physical examination form:

1. Students who are newly enrolling in a school or educational institution often need to fill out a physical examination form. This helps ensure that they are in good health and able to participate in educational activities.
2. Student athletes may be required to undergo a physical examination to ensure that they are fit to engage in sports and physical activities.
3. Some programs or activities, such as summer camps or study abroad programs, may require students to submit a physical examination form to ensure their overall well-being during the duration of the program.
4. Students who have specific health concerns or medical conditions may also be asked to complete a physical examination form to provide relevant medical information to the school or institution for their safety and well-being.

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What is student physical examination form?

Student physical examination form is a document that collects information about a student's medical history, current health status, and any physical limitations or conditions that may affect their ability to participate in certain activities.

Who is required to file student physical examination form?

All students, usually those entering a new school or grade level, are required to file a student physical examination form.

How to fill out student physical examination form?

To fill out a student physical examination form, you need to provide accurate information about the student's personal details, medical history, current health status, any medications being taken, and any relevant medical conditions or limitations. The form may also require signatures from both the student and a healthcare professional.

What is the purpose of student physical examination form?

The purpose of the student physical examination form is to ensure that students are in good health, identify any medical conditions that may require special attention or accommodation, and promote the overall well-being of the student population.

What information must be reported on the student physical examination form?

The student physical examination form typically requires information such as the student's name, date of birth, address, medical history, health insurance details, immunization records, any current medications, and any specific medical conditions or allergies.