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Date of exam // Additional Comments Name of Physician/Primary Care Practitioner PCP License Physician/PCP s Signature Health Status Statement Form Date //. HEALTH STATUS STATEMENT FORM Notice to Applicant This physician s statement must be completed before you can begin any assignment with Maxim. Please DO NOT delay sending your completed application and other forms. This statement may be sent at a later date but must be sent prior to the start of your employment. APPLICANT INFORMATION Please Print Name Home Address City State Zip code TESTS PERFORMED Applicant must have TB skin test performed unless contraindicated by MD TB Skin Test Date Performed // Date Read // 2nd Step TB Skin Test Date Performed // TB skin test is contraindicated Results Yes No If yes refer to chest x-ray Chest X-Ray if skin test N/A Date Performed // Results/Evidence of tuberculosis Reason chest x-ray performed history of positive PPD allergy to serum other provide details TB test results must be current within ....

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Related content

Health Status - HealthCare.gov Glossary |...
Refers to your medical conditions (both physical and mental health), claims experience...
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Current Health Status, History // Purdue Writing...
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Health - Wikipedia
Health is a state of physical, mental and social well-being in which disease and infirmity...
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Board Directors Minutes - Free Legal Forms Request For Subpoena - Nueces County - Co Nueces Tx Revocable Two-Party Living Trust. Software Guide Birth Certificate Request Form - State Of Oklahoma - Tulsa-health

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Examples include functional health, disability days, activity limitation, health expectancy, disability free life expectancy.

Health status is a measure of how people perceive their health—rating it as excellent, very good, good, fair, or poor. Reported health status is a predictor of important health outcomes including mortality, morbidity, and functional status (1–4).

The health status of a population can be measured by a wide range of factors: birth and death rates, life expectancy, quality of life, morbidity from specific diseases and conditions, environmental risk factors, use of ambulatory care and inpatient care, financial and geographical accessibility of health personnel and ...

Individual health status refers to a person's overall physical, mental, and social well-being, as well as freedom from illness or injury. In contrast, individual disease status refers to a person's physical or mental symptoms with or without diagnosis [9].

Health Status: Definition and Measurement More specifically, health status can be defined as the range of manifestation of disease in a given patient including symptoms, functional limitation, and quality of life, in which quality of life is the discrepancy between actual and desired function (Figure 1).

Examples include functional health, disability days, activity limitation, health expectancy, disability free life expectancy.

Health status is an individual's relative level of wellness and illness, taking into account the presence of biological or physiological dysfunction, symptoms, and functional impairment. Health perceptions (or perceived health status) are subjective ratings by the affected individual of his or her health status6.

Refers to your medical conditions (both physical and mental health), claims experience, receipt of health care, medical history, genetic information, evidence of insurability, and disability.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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