Get (to Be Completed By The Healthcare Practitioner) - Kirkwood

Filling out the (To Be Completed By The Healthcare Practitioner) - Kirkwood form is a vital step in ensuring comprehensive health assessments for students. This guide provides a clear, step-by-step instruction to assist practitioners in completing the form efficiently and accurately online.

Follow the steps to effectively complete the form

1. Click the ‘Get Form’ button to access the form and open it in your preferred editing software.
2. Begin by filling out the basic information fields such as the name, date of birth (DOB), K number, and program. Ensure each entry is accurate as this information is essential for future reference.
3. In the allergies section, input any known allergies, including drug, latex, environmental, and food allergies. Precise detailing is crucial for safety.
4. Record the patient's height (HT), weight (WT), blood pressure (BP), pulse, respiratory rate (Resp.), and temperature (Temp.). These metrics provide a snapshot of the patient's health status.
5. Conduct an eye exam if necessary, using a Snellen chart. Indicate the results for the right (Rt.) and left (Lt.) eyes and note if glasses or contacts were utilized for the examination.
6. Assess and mark any abnormalities in the health screening sections: head, ears, nose, throat, eyes, upper respiratory, lungs, cardiovascular, gastrointestinal/rectal, assistive hearing device, hernia, genitourinary/pelvic, musculoskeletal, metabolic/endocrine, neuro, and skin. Respond with 'Yes' or 'No' as appropriate.
7. Address the specific illnesses listed. If any conditions apply, provide detailed comments explaining them.
8. List current prescriptions and over-the-counter medications the patient frequently uses. This will aid in understanding their treatment regimen.
9. Detail any surgeries the patient has undergone along with the corresponding years.
10. Indicate if there are any recommendations, precautions, or limitations regarding the student's role in patient contact. If applicable, provide further comments.
11. Based on your findings, determine if the student should be restricted from patient contact and mark 'Yes' or 'No' accordingly.
12. Finally, sign and print your last name in the designated verification section. Include the clinic or office official stamp, a telephone number, and the date of completion before submitting the form.

Complete your documents online with ease and accuracy!