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HILLSBOROUGH COUNTY, FLORIDA PUBLIC SCHOOLS APPLICATION CENTER 1202 East Palm Avenue, Tampa, FL 33605 EMPLOYMENT REFERENCE FORM SECTION A: APPLICANT: PLEASE COMPLETE THIS SECTION AND PROVIDE THE FORM

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What is clinicians affidavit and report?

Clinicians affidavit and report is a document prepared by medical professionals or clinicians, which includes detailed information about a patient's medical condition, treatment, and prognosis.

Who is required to file clinicians affidavit and report?

Clinicians or medical professionals who have treated a patient and have relevant medical information are required to file clinicians affidavit and report.

How to fill out clinicians affidavit and report?

To fill out clinicians affidavit and report, the medical professional needs to provide accurate and detailed information about the patient's medical condition, treatment administered, medical history, and prognosis. The report should be signed and dated by the clinician.

What is the purpose of clinicians affidavit and report?

The purpose of clinicians affidavit and report is to provide a comprehensive summary of a patient's medical condition, treatment received, and prognosis, which can be used for legal or administrative purposes.

What information must be reported on clinicians affidavit and report?

Clinicians affidavit and report should include information such as the patient's medical history, current medical condition, prescribed medications, procedures performed, test results, and the clinician's professional opinion or diagnosis.

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