Get Supplemental Page B Medical Examination Form - Web Peralta

Completing the Supplemental Page B Medical Examination Form is an essential step in your application process. This guide will provide you with clear and concise instructions to help you confidently fill out the form online.

Follow the steps to successfully complete your Medical Examination Form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by filling in the student name and date of birth fields at the top of the form. Make sure to enter the date in the format of month, day, year.
3. Proceed to the medical examination section, which must be completed and signed by a qualified physician. If you choose, you can submit a copy of your immunization records instead of filling this section out.
4. In the description section, review each medical requirement. Check the 'Yes' or 'No' boxes as applicable for the following immunizations: Tetanus-Diphtheria, M.M.R., Measles, Rubella, and Mumps.
5. For each immunization, note the respective dates in the 'Date' field provided. Ensure these are in 'mm/yy' format.
6. Complete the tuberculosis section by indicating the results of the PPD (Mantoux) test. Select 'Yes' or 'No', and if tested, include the test result and date.
7. Fill in the physician information section at the end of the form. This includes the physician's name, phone number, address, city/country, medical number, and email address.
8. Ensure the physician signs and dates the form in the indicated fields. This signature is required for the submission.
9. Once all the information is filled out, you can save the changes, download the completed form, print it, or share it as needed. Ensure that the form is returned with your application or sent via fax or email.

Complete your Supplemental Page B Medical Examination Form online today for a smooth application process.