Get Form 5188

Filling out Form 5188 is an important step in obtaining certification to provide care for individuals with disabilities. This guide will walk you through the essential sections of the form and provide you with clear instructions to ensure a smooth process.

Follow the steps to accurately complete the Form 5188 online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the applicant's name in the designated field. Ensure the name is spelled correctly as it appears on official documents.
3. Next, fill in the date using the format YYYYMMDD. This date indicates when the assessment is being conducted.
4. Identify the examining physician by entering their name in the appropriate section. This is critical for the validation of the form.
5. Respond to the first question regarding the applicant's health. Check the 'YES' or 'NO' box as applicable and provide explanations for any 'NO' answers in the space provided.
6. Proceed to the second question about any nervous or emotional disorders. Again, select 'YES' or 'NO' and elaborate if necessary.
7. For the third question concerning the applicant's capability to care for individuals with disabilities, select the appropriate box and offer explanations where needed.
8. If applicable, fill in the date and results of the chest X-ray or tuberculin test. Include whether the result was positive or negative.
9. Enter the typed name and address of the examining physician to establish their credentials and contact information.
10. Have the applicant sign and date the form to confirm the information provided is accurate and complete.
11. Lastly, complete the permission for release of medical information section by entering the date and ensuring the applicant agrees to the terms.

Complete your Form 5188 online today to begin the certification process.