Get Red Cross Physical Form

Filling out the Red Cross Physical Form is an essential step for individuals pursuing certification as a nurse assistant or home health aide. This guide provides a clear, step-by-step approach to completing the form online, ensuring that all required information is accurately captured.

Follow the steps to successfully complete the form.

1. Press the 'Get Form' button to obtain the form and open it in your selected editor.
2. Fill in your personal information, including your name, sex (select M or F), birthdate, address, city, state, zip code, and phone number.
3. Indicate if you have had a serious illness, injury, or surgery by providing details in the specified area.
4. Have the examining physician or nurse practitioner complete the relevant sections, including current complaints or disabilities that may affect your education in nurse assistant or home health aide training.
5. List any medications you are currently using, including both prescription and over-the-counter medications. Use the provided space on the form to give details about each medication, including its indication and frequency.
6. Provide a summary of your significant medical history, covering aspects such as accidents, surgeries, or communicable diseases.
7. The examining physician or nurse practitioner should enter their examination comments and findings in the designated area.
8. Ensure to complete the tuberculosis screening section by recording the date and results of the P.P.D. test. If the result is positive, include the date and results of the chest X-ray.
9. If applicable, document your immunization history by entering dates and providing copies of immunization records or serological confirmation. Include information about diphtheria and tetanus, polio, rubeola, and rubella.
10. The examining professional should provide their name, signature, address, and phone number, along with the date of examination.
11. As a student, sign the form, indicating your consent to release a copy to the affiliating clinical facility, and include the date.
12. Finally, ensure that you attach the results of the P.P.D. and chest X-ray along with the completed form.

Get started today by completing your Red Cross Physical Form online!