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Get the free Certificate of Medical Examination (2012 Version). Operational Form 178, Formerly SF 78

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To be given to the individual examined with a readdressed envelope marked Confidential Medical. CERTIFICATE OF MEDICAL EXAMINATION U.S. OFFICE OF PERSONNEL MANAGEMENTForm Approved OMB No. 3206 0250Privacy
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How to fill out certificate of medical examination

01
Step 1: Obtain the certificate of medical examination form from the relevant authority or healthcare provider.
02
Step 2: Fill in your personal information such as name, date of birth, and contact details.
03
Step 3: Provide information about your medical history, including any previous illnesses, surgeries, or medications.
04
Step 4: Complete the section regarding the purpose of the examination, such as employment or travel.
05
Step 5: If required, undergo a medical examination by a qualified healthcare professional.
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Step 6: Have the healthcare professional fill in the necessary medical assessment details, including physical examination results and any recommended tests.
07
Step 7: Review the completed form for accuracy and completeness.
08
Step 8: Sign and date the certificate of medical examination.
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Step 9: Submit the completed form to the appropriate authority or organization that requested the certificate.

Who needs certificate of medical examination?

01
Individuals applying for employment in certain industries may need to provide a certificate of medical examination as part of their pre-employment screening.
02
International travelers may require a certificate of medical examination to meet the health requirements of the destination country.
03
In some cases, individuals applying for a driver's license or other licenses may need to submit a certificate of medical examination.
04
Certain educational institutions or programs may require students to provide a certificate of medical examination.
05
Athletes participating in sports events or competitions may need to provide a certificate of medical examination as proof of their physical fitness.
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A certificate of medical examination is a document confirming that an individual has undergone a medical evaluation.
Certain job positions or industries may require individuals to submit a certificate of medical examination as part of their employment requirements.
Individuals can fill out a certificate of medical examination by providing accurate information about their medical history and undergoing a physical examination by a licensed healthcare provider.
The purpose of a certificate of medical examination is to ensure that individuals are physically fit to perform specific tasks or duties.
Information such as medical history, physical assessment findings, and any recommendations from the examining healthcare provider may need to be reported on the certificate.
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