Get the free Medical Clearance Form, CWL-3704 - State of Michigan
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MEDICAL CLEARANCE REQUEST
Michigan Department of Human Services
Office of Children and Adult Licensing
APPLICANT/LICENSEE INFORMATION
Facility/Home NameLicense NumberFacility/Home Address (Street
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How to fill out medical clearance form cwl-3704
How to fill out medical clearance form cwl-3704
01
Obtain a copy of medical clearance form cwl-3704.
02
Fill out your personal information including name, date of birth, and contact information.
03
Provide information about your medical history, including any pre-existing conditions or medications you are currently taking.
04
Answer any specific questions on the form related to previous surgeries, hospitalizations, or medical treatments.
05
Have a healthcare provider review and sign the form to confirm your medical clearance.
06
Submit the completed form to the requested organization or entity as directed.
Who needs medical clearance form cwl-3704?
01
Individuals who are required to undergo a medical evaluation before participating in certain activities or events.
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What is medical clearance form cwl-3704?
It is a form required to be filled out by individuals to provide medical clearance for certain activities.
Who is required to file medical clearance form cwl-3704?
Anyone participating in activities that require medical clearance.
How to fill out medical clearance form cwl-3704?
The form must be filled out completely and accurately with information about the individual's medical history.
What is the purpose of medical clearance form cwl-3704?
The purpose is to ensure that individuals are medically fit to participate in specific activities.
What information must be reported on medical clearance form cwl-3704?
Information such as medical history, current medications, allergies, and any existing medical conditions.
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