Get the free Physician's Statement of Examination (DI-4P) - Michigan

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Medical AlertWelcome to Dr. Been George DentistryPatient ID×Please fill out the following information. PLEASE PRINT. Patient Information The patient is an: Adult Child Adult under Guardianship Name

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What is physicians statement of examination?

Physician's statement of examination is a report filled out by a doctor that provides an evaluation of a person's health.

Who is required to file physicians statement of examination?

Individuals who are applying for certain jobs or benefits may be required to file a physician's statement of examination.

How to fill out physicians statement of examination?

To fill out a physician's statement of examination, the individual must schedule an appointment with their doctor for a physical examination and have the doctor complete the form with their findings.

What is the purpose of physicians statement of examination?

The purpose of a physician's statement of examination is to assess the health and medical condition of an individual for employment or benefit eligibility.

What information must be reported on physicians statement of examination?

The physician must report on the individual's current health status, any medical conditions or disabilities, medications being taken, and any recommendations for medical treatment.

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