
Office of Early Learning and School ReadinessEmployee Medical Statement Revised 3/12/2018This form meets Ohio Administrative Code. Programs may use this form or build their own.Section I Medical Provider.
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How to fill out the OH Employee Medical Statement online
The OH Employee Medical Statement is an essential document to verify an employee’s medical fitness for working with children. This guide will provide a clear, step-by-step process to help you complete the form online with confidence.
Follow the steps to fill out the OH Employee Medical Statement seamlessly.
- Click ‘Get Form’ button to obtain the OH Employee Medical Statement and open it in an editable format.
- In Section I, fill in the medical provider information. Include the name of the physician, clinic, or hospital, complete with the provider's address, phone number, city, state, and zip code.
- Proceed to Section II, where you will provide your name as the employee and certify your medical status. Select the checkbox indicating whether you are free of communicable diseases and if you are fit to work with children. If there are any medical limitations, please provide the details in the designated area.
- Identify the examining medical professional by checking the appropriate box for either a physician, physician assistant, or advanced practice registered nurse.
- Ensure the medical professional provides their signature along with the date of evaluation to verify the accuracy and completeness of the information presented.
- Finally, review all sections for accuracy. Once satisfied, you can save your changes. Options may include downloading, printing, or sharing the completed form as needed.
Complete your OH Employee Medical Statement online today!
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