MA DDS Form HC-4 2003 free printable template

ANNUAL PHYSICAL EXAMINATION FORM PAGE 1 OF 2. Massachusetts Department of Mental Retardation. Name: Date: Vital Signs: Ht. Wt. T. BP. P. R.

How to fill out MA DDS Form HC-4

How to fill out MA DDS Form HC-4

1. Obtain the MA DDS Form HC-4 from the Massachusetts Registry of Motor Vehicles website or your local RMV office.
2. Fill out the personal information section, including your name, address, and telephone number.
3. Provide details regarding your disability, including the nature of the disability and any relevant medical information.
4. Ensure you have the necessary physician’s certification by having a licensed healthcare provider complete the required section.
5. Review your completed form for accuracy and completeness.
6. Sign and date the form at the designated space.
7. Submit the completed form either by mail to the appropriate address or in-person at your local RMV office.

Who needs MA DDS Form HC-4?

1. Individuals applying for a disability parking permit in Massachusetts.
2. People who need to document their disability status for eligibility in special parking privileges.
3. Those who are renewing or updating their existing disability parking permit.

People Also Ask about

What is one part of a physical exam?

Elements of a Physical Exam It measures important vital signs -- temperature, blood pressure, and heart rate -- and evaluates your body using observation, palpitation, percussion, and auscultation. Observation includes using instruments to look into your eyes, ears, nose, and throat.

What is usually included in an annual physical exam?

Basic vitals including height, weight, hearing, vision, blood pressure, heart rate, body mass index (BMI), and an ears, nose, and throat check. Screenings for certain types of cancer including prostate exams for men and breast exams for women.

What is the difference between routine physical exam and annual physical exam?

While a physical includes a full examination and a wellness evaluation, an Annual Wellness Visits focuses solely on a patient's answers to a health risk assessment. It does not typically include any lab work or tests requiring physical contact.

What is the order of the physical exam system?

Order of physical assessment: Inspect, palpate, percuss, auscultate. EXCEPT for assessing the abdomen: Inspect, auscultate, percuss, palpate (to avoid altering bowel sounds).

What does a full physical exam include?

A thorough physical examination covers head to toe and usually lasts about 30 minutes. It measures important vital signs -- temperature, blood pressure, and heart rate -- and evaluates your body using observation, palpitation, percussion, and auscultation.

What is annual physical exam anxiety?

It's normal to be nervous about your annual primary care visit, but it's important to get past the nerves and develop a relationship with a primary care provider. Your provider can help prevent disease, manage chronic conditions, get referrals for tests or specialists and more.

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What is MA DDS Form HC-4?

MA DDS Form HC-4 is a document used in Massachusetts to report specific health-related information for the purposes of determining eligibility for disability benefits.

Who is required to file MA DDS Form HC-4?

Individuals applying for disability benefits under the Massachusetts Disability Determination Services (DDS) are required to file MA DDS Form HC-4.

How to fill out MA DDS Form HC-4?

To fill out MA DDS Form HC-4, the applicant must complete the form by providing accurate information about their medical condition, treatment history, and any relevant personal details as specified in the form guidelines.

What is the purpose of MA DDS Form HC-4?

The purpose of MA DDS Form HC-4 is to collect necessary medical information to assist in the evaluation of an individual's claim for disability benefits.

What information must be reported on MA DDS Form HC-4?

MA DDS Form HC-4 requires reporting information such as medical diagnoses, treatment dates, healthcare provider details, and any medications being taken by the applicant.