Get Medical Examination Report Form

Completing the Medical Examination Report Form online is an essential task for ensuring accurate health assessments. This guide will walk you through each component of the form to facilitate a smooth online submission process.

Follow the steps to fill out the Medical Examination Report Form online:

1. Press the ‘Get Form’ button to access the Medical Examination Report Form and open it in your preferred online editor.
2. Fill in the date at the top of the form to indicate when the examination is being reported.
3. Provide the applicant's name, ensuring you include their last name, first name, and middle name as required.
4. Record the height and weight of the applicant in the designated fields to maintain accurate health records.
5. For the vision section, note whether the applicant wears glasses or contacts. Conduct the visual acuity test and record the results for each eye, both with and without corrective lenses.
6. Document the applicant's depth, color, and peripheral vision perception, marking them as normal or abnormal.
7. In the hearing section, assess each ear for normal or abnormal hearing acuity. Use a whispered conversation at 15 feet as a reference and note any abnormalities.
8. Record the applicant's blood pressure and resting pulse, as well as results from the cardiac examination, peripheral circulation, and EKG. Note any abnormalities that arise.
9. Evaluate and provide details under the HEENT, lungs, abdomen, musculoskeletal, genitourinary, neurological, and skin sections, indicating normal or abnormal findings.
10. Complete the urinalysis section, marking it as normal or noting any abnormalities.
11. Answer the questions regarding any conditions suggesting further examination and whether there are reservations about the candidate's ability to perform required duties.
12. Sign the form as the physician, including the date of completion, and print your name and address as required.
13. Finally, save your changes, download the completed form, print a copy, or share it as needed.

Complete your Medical Examination Report Form online today!