Get Dds Medical Evaluation Form (8/27/2013) - The District Of Columbia - Dds Dc

This guide aims to assist users in completing the DDS Medical Evaluation Form accurately and efficiently. By following the provided steps, individuals can ensure that all necessary information is documented for the evaluation process.

Follow the steps to successfully complete the form.

1. Click the 'Get Form' button to access the Medical Evaluation Form and open it in your preferred form editor.
2. Begin by filling in your name, date of evaluation, date of birth (DOB), social security number (SSN), and the name of the guardian, if applicable. Ensure all these fields are completed to avoid delays in processing.
3. In the section for disabilities, check any items that are associated with the diagnosis of an intellectual or developmental disability. Options include Down syndrome, cerebral palsy, and other relevant conditions.
4. List any known medical and psychiatric diagnoses in the designated area. Include up to six diagnoses to give providers a comprehensive view of the individual's health status.
5. Document any current medications being taken, listing up to ten medications. This helps in addressing interactions and ensuring appropriate care.
6. If there are any allergies to drugs or food, note them in the specified section. Include 'None' if there are no known allergies.
7. Indicate results for chest x-ray or PPD tests, mammogram results, and vaccination status for hepatitis B by circling the appropriate options and including dates.
8. Provide details on developmental history, current complaints, significant past medical history, habits, and substance abuse, as applicable. Be thorough but concise.
9. In the social and sexual history sections, add relevant concerns that may impact health. This information is vital for comprehensive care.
10. Complete the physical exam section with observations such as height, weight, blood pressure, and other relevant data to establish a health baseline.
11. Attach any lab results and list them in the provided space to ensure all medical information is available for review.
12. Conclude by stating any specific recommendations and clinical services needed. This assists in planning future care.
13. Finally, ensure that the medical provider's name is printed, along with their signature, address, telephone, and fax number. This confirms the authenticity of the evaluation.
14. Once all fields are completed, save your changes, download, print, or share the form as needed.

Complete your DDS Medical Evaluation Form online today to streamline the evaluation process.