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Form 75.880 Rev. 05/00, 09/05 EVANSVILLE-VANDERBURGH SCHOOL CORPORATION HEALTH SERVICES DEPART ENT EVANSVILLE, INDIANA Home Room Teacher Physical Examination Record (To be filled out only by a physician)

How to fill out physical examination form

How to fill out a physical examination form:

1. Start by carefully reading the instructions provided on the form. Understand what information is required and how it should be presented.
2. Fill in your personal details accurately and legibly. This includes your full name, date of birth, gender, contact information, and any other relevant identification details.
3. Provide your medical history. This may include previous illnesses, surgeries, allergies, chronic conditions, medications you are currently taking, and any other pertinent medical information.
4. Fill in details about your vaccination history, including the dates and types of vaccines you have received. Some forms may also require information about the vaccines you had as a child.
5. Record any episodes of major illnesses or hospitalizations you have experienced. Specify the dates, reasons, and any treatments provided.
6. Document your family medical history, including any instances of chronic diseases or genetic conditions among your close relatives.
7. Provide your lifestyle information, such as your diet, exercise routine, smoking or alcohol habits, and any other relevant details that may impact your health.
8. Answer questions regarding your current symptoms, if any. Be honest and provide as much detail as possible to assist the healthcare professional in assessing your health accurately.
9. If required, provide additional information such as your blood type, height, weight, and blood pressure measurements. Some forms may also require you to undergo certain tests, such as blood work or a urine sample.
10. Review the completed form for any errors or omissions. Make sure all sections have been filled out and that the information provided is correct and up to date.
11. Sign and date the form to certify that the information you have provided is true and accurate.
12. Keep a copy of the completed form for your records.

Who needs a physical examination form?

A physical examination form is typically required by various individuals and organizations. Some common examples include:

1. Students: Many schools, colleges, and universities require students to complete a physical examination form before enrolling in classes or participating in sports activities.
2. Employees: Some employers may request a physical examination form as part of their hiring process, especially for physically demanding jobs or positions that involve the safety of others.
3. Athletes: Sports organizations, teams, and leagues often require athletes to undergo a physical examination before participating in competitions or joining a team.
4. Medical professionals: Physical examination forms are sometimes used by healthcare institutions to assess the health of medical professionals, ensuring they are fit to fulfill their duties.
5. Immigration purposes: When applying for immigration to certain countries, individuals may be required to provide a physical examination form to demonstrate their overall health and well-being.
6. Insurance companies: Some insurance providers may request a physical examination form as part of the underwriting process to assess an individual's health and determine premium rates.

It's important to note that the specific requirements and purposes of physical examination forms may vary depending on the institution or organization requesting them. Therefore, it is always advisable to carefully follow the instructions provided and seek clarification if needed.

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What is physical examination form?

The physical examination form is a document used to record the results of a medical examination conducted to assess an individual's overall health and fitness.

Who is required to file physical examination form?

The physical examination form is usually required to be filed by individuals in certain professions such as healthcare workers, athletes, and individuals applying for certain jobs or licenses that require a physical assessment.

How to fill out physical examination form?

To fill out a physical examination form, you need to provide accurate and detailed information about your medical history, current medications, allergies, and undergo various tests conducted by a healthcare professional, including measurements of height, weight, blood pressure, and laboratory tests.

What is the purpose of physical examination form?

The purpose of the physical examination form is to assess an individual's overall health, identify any existing medical conditions or potential risks, and ensure that the individual meets the requirements or standards set by an organization, employer, or regulatory body.

What information must be reported on physical examination form?

The physical examination form typically requires information such as personal details (name, date of birth, contact information), medical history, current medications, allergies, vital signs, laboratory results, and the healthcare professional's evaluation.