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Phone: (866) 346-8522 Fax: (954) 755-0819 or (954) 346-4485 or (866) 886-1882 Statement of Physical Examination Personal Data Please Print Name: Address: Street Last First City Middle Social Security
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How to fill out statement of physical examination

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How to fill out a statement of physical examination:

01
Start by carefully reading and understanding the instructions provided. Make sure you have all the necessary forms and documents required for the examination.
02
Begin by entering your personal information in the designated sections, including your full name, date of birth, address, and contact details.
03
Next, provide details about your medical history. This may include any previous surgeries, illnesses, chronic conditions, allergies, or medications you are currently taking. Be thorough and provide accurate information to ensure the examiner has a complete understanding of your medical background.
04
In the statement of physical examination, you will typically find sections related to different body systems such as cardiovascular, respiratory, musculoskeletal, and neurological. Fill out each section honestly and to the best of your knowledge. If you are unsure about any specific aspects, it is recommended to consult with a healthcare professional for clarification.
05
The examination form may also require you to disclose any known disabilities or limitations that could impact your ability to perform certain activities or jobs. It is important to be truthful and provide all relevant information.
06
Some forms may also have sections related to lifestyle habits such as smoking, alcohol consumption, or recreational drug use. If applicable, answer these questions accurately as they can have an impact on your overall health assessment.
07
Depending on the purpose of the physical examination, there may be additional sections or requirements to fulfill. For example, if the examination is for employment purposes, the form might include a section for the examiner's evaluation and overall conclusion.

Who needs a statement of physical examination:

01
Individuals applying for a new job or promotion may be required to submit a statement of physical examination as part of the pre-employment screening process. This helps employers assess the candidate's overall health and fitness for the position.
02
Students applying for certain educational programs, such as healthcare or sports-related courses, may need to provide a statement of physical examination to ensure they meet the physical requirements of the program. This is to ensure that students are physically capable of practicing the skills necessary for their chosen field.
03
Athletes participating in organized sports or competitions often require a statement of physical examination to determine their fitness, identify any potential health risks, and ensure they are cleared for participation.
04
Individuals applying for certain licenses or permits, such as driving licenses or pilot licenses, may need to undergo and submit a statement of physical examination to demonstrate their physical fitness and ability to safely perform the tasks associated with the license.
Overall, the statement of physical examination is a document that provides a comprehensive overview of an individual's health and fitness status. It is vital to accurately fill out the form and provide all necessary information to ensure an accurate assessment can be made.
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The statement of physical examination is a document that includes the results of a medical examination to evaluate a person's physical health.
Certain individuals, such as athletes, employees in safety-sensitive positions, and applicants for certain licenses or permits, may be required to file a statement of physical examination.
To fill out a statement of physical examination, an individual must provide their personal information, medical history, and undergo a physical examination conducted by a healthcare provider.
The purpose of the statement of physical examination is to assess an individual's physical health and determine if they meet the required standards for a specific purpose, such as participating in a sport or obtaining a professional license.
The statement of physical examination typically includes personal information, medical history, results of physical examination, and any recommendations or restrictions from the healthcare provider.
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