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  • Physician Written Statement For Asbestos Exposure

Get Physician Written Statement For Asbestos Exposure

Applicant Name: (First, M.I., Last) Social Security # Street Address: Date of Birth City ) Telephone Number (including area code) State Zip INDICATE WHICH ITEMS WERE PERFORMED WITH PHYSICIAN'S OR ASSISTANT'S INITIALS: (Any that are not applicable, must still be initialed off in addition to the N/A.) The above-named individual was seen on (Must be filled-in by Physician or clinic.) Completion and review of the standardized medical questionnaire and work history with special emphasis.

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Symptoms Shortness of breath. A persistent, dry cough. Chest tightness or pain. Dry and crackling sounds in your lungs when you inhale. Fingertips and toes that appear wider and rounder than usual (clubbing)

Computerized tomography (CT) scan. These scans generally provide greater detail and might help detect asbestosis in its early stages, even before it shows up on a chest X-ray.

The latency period for mesothelioma refers to the time between initial exposure to asbestos and the patient's diagnosis. Mesothelioma typically takes 20 to 60 years to develop after asbestos exposure. Symptoms may not present until later stages of the cancer.

As part of your evaluation, your health care provider discusses your health history, occupation and exposure risk to asbestos. During a physical exam, your health care provider uses a stethoscope to listen carefully to your lungs to determine if they make a crackling sound while inhaling.

A thorough physical examination, including a chest x-ray and lung function tests, may be recommended. The chest x-ray is currently the most common tool used to detect asbestos-related diseases.

Studies indicate that approximately 2% to 10% of people regularly exposed to asbestos are diagnosed with pleural mesothelioma, the most deadly form of asbestos-related cancers. Most research indicates that mesothelioma does not usually manifest until 20 to 50 years following asbestos exposure.

There is no blood test for asbestos exposure. Instead, doctors use detailed imaging scans plus tissue biopsies. Together, they diagnose asbestos illnesses.

A statement that the employee has been informed by the physician of the results of the consultation or medical examination and any medical condition that may require further examination or treatment.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232