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Media Occupational Health Services 1824 SW White Birch Circle Ankeny, Iowa 50023 515.964.9003 Phone 515.964.9032 Fax www.gotomedix.com John D. Klein, DO, MPH, TIME, FA CPM, FAC OEM Robin L. Sass man,
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How to fill out a preplacement medical history questionnaire:

01
Read the questionnaire carefully to understand what information is being asked for. Make sure to follow any instructions provided.
02
Start by providing basic personal details such as your name, date of birth, and contact information.
03
Move on to the medical history section. Provide information about any past or current medical conditions you have, including allergies, chronic illnesses, surgeries, or hospitalizations.
04
Include details about any medications you are currently taking, including dosage and frequency.
05
Be honest and thorough when answering questions about your lifestyle habits such as smoking, alcohol consumption, and exercise routine.
06
If you have had any previous occupational exposures to hazardous substances or any work-related injuries or illnesses, make sure to mention them.
07
Answer questions about your family medical history, including any genetic conditions that may run in your family.
08
If the questionnaire asks about any previous legal issues or convictions, answer truthfully.
09
Include any additional information that you think may be relevant to your health or the nature of the job you are applying for.
10
Once you have completed the questionnaire, review your answers to ensure accuracy and completeness. If necessary, seek clarification or assistance from a healthcare professional.

Who needs a preplacement medical history questionnaire:

01
Job applicants: Many employers require prospective employees to fill out a preplacement medical history questionnaire to assess their overall health and suitability for the job.
02
Occupational health professionals: Doctors, nurses, and other healthcare professionals may use the information provided in the questionnaire to evaluate potential health risks and determine appropriate measures for workplace safety.
03
Employers: Employers use the information gathered from the preplacement medical history questionnaire to make informed decisions while hiring, considering the health and safety implications for both the individual and the organization.
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A preplacement medical history questionnaire is a form that collects information about an individual's health history prior to starting a new job.
Employees who are starting a new job are required to fill out and file a preplacement medical history questionnaire.
To fill out a preplacement medical history questionnaire, individuals need to provide accurate information about their medical history, current health status, and any medications they may be taking.
The purpose of a preplacement medical history questionnaire is to assess an individual's health status before they start a new job in order to ensure they are fit to perform the required duties.
Information such as medical conditions, allergies, medications, surgeries, and family history of certain diseases must be reported on a preplacement medical history questionnaire.
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