Get Health Examination Record Form

This guide provides clear and supportive instructions for users on how to complete the Health Examination Record Form online. By following these steps, you can ensure that all necessary information is accurately provided for the health examination process.

Follow the steps to fill out the Health Examination Record Form online successfully.

1. Press the ‘Get Form’ button to access the Health Examination Record Form and open it in your preferred online editor.
2. Begin by entering the name of the individual (last name, first name, and initial) at the top of the form.
3. Input the name of the parent or guardian responsible for the health information.
4. Fill in the address, including the city or town, state, and zip code.
5. In the section labeled 'In Emergency Notify', provide the name and address of a contact person and their phone number.
6. Indicate the sex of the individual and complete the group number, if applicable.
7. Check any relevant health history boxes related to diseases or allergies, detailing which apply.
8. Complete the insurance information section, including the carrier name, ID number, and member services phone number.
9. If applicable, detail any chronic or recurring illnesses by checking the appropriate boxes and providing additional information.
10. Provide suggestions from the parent or guardian about any medications the individual has permission to take.
11. Describe any past operations, serious injuries, hospitalizations, other diseases or disabilities, and include relevant dates.
12. In the comments section, note any additional health concerns such as fainting, bedwetting, constipations, emotional disturbances, etc.
13. Specify any special medical or dietary regimens that need to be followed.
14. Include the signature of the parent or guardian along with the date to verify the accuracy of the information provided.
15. For the physician's section, ensure that the reviewing physician completes the required medical examination details.
16. Save your changes, and once completed, you may download, print, or share the form as needed.

Complete your Health Examination Record Form online today to ensure a smooth health examination process.