Get Revised January 12, 2009 Cedar Rapids Community School District Health Status Form A Physical Exam

Completing the Cedar Rapids Community School District Health Status Form A Physical Exam online is a crucial step for ensuring that students receive the necessary health evaluation for athletic participation. This guide will provide you with clear, step-by-step instructions to easily fill out and submit the form.

Follow the steps to accurately complete the health status form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the student's name and birth date at the top section of the form. This information helps identify the individual requiring the health examination.
3. Next, indicate the school, grade, and the student's sex by selecting from the available options.
4. Complete the parent/guardian section by providing the name and home phone number of the primary contact responsible for the student.
5. In the section directed to parents/guardians, note any significant medical or health problems in family members that could impact the child’s health and school performance.
6. Consent to exchange information by signing in the designated area. This step confirms the parent/guardian's agreement for the school nurse to communicate with the healthcare provider.
7. Record the date and the date of the exam to maintain proper medical documentation and tracking.
8. Provide the healthcare provider's details, including their printed name and signature, and the date of signing, ensuring their oversight during the physical examination is documented.
9. Complete the remaining health status questions that the healthcare provider should fill out, covering topics like significant health histories, vision and hearing impairments, and conditions that may affect the student's school day.
10. After all sections have been accurately filled in, carefully review the form for any errors or omissions before proceeding to save, download, or print the document for submission to the school.

Begin filling out the health status form online today to ensure a smooth process for your student’s participation in athletics.