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H511.336 (Rev. 9/2012)Page 1 of 4: STUDENT HISTORYPARENT / GUARDIAN / STUDENT:Private or School PHYSICAL EXAMINATIONComplete page one of this form before SCHOOL AGE STUDENTBureau of Community Health
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The date of exam is the specific date on which an examination or test is scheduled to take place.
The date of exam is typically required to be filed by the educational institution or examination board conducting the exam.
The date of exam can be filled out by entering the day, month, and year on the designated form or online portal.
The purpose of the date of exam is to provide a clear and accurate schedule for when the examination will take place.
The date of exam must include the specific date, time, and location of the examination.
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