Get Report Of Medical Examination - Chabot College - Chabotcollege

Filling out the Report of Medical Examination is a crucial step for students entering the Nursing Program at Chabot College. This guide provides a clear, step-by-step approach to help you complete the form accurately and efficiently.

Follow the steps to complete the medical examination report with ease.

1. Click the ‘Get Form’ button to access the REPORT OF MEDICAL EXAMINATION and open it for editing.
2. Begin by selecting the appropriate program you are applying for by checking the box for the Nursing Program.
3. Fill in your personal information, including your name, sex, address, phone number, date completed, birth date, and email. Ensure all details are accurate.
4. Complete the required immunization section. Attach hard copy documentation for all immunization records and the Titer Report. If you have a positive PPD result, include chest X-ray results.
5. Record the dates and results of your TB tests in the designated fields. Ensure that the 2-step test is completed by the specified deadlines.
6. Provide information for the required Titer Reports, including dates and results for Rubella, Rubeola, Mumps, Varicella, and Hepatitis B. Note any booster requirements.
7. Have your health care provider complete the examination section, including current complaints, significant medical history, routine medications, and any relevant examination findings.
8. Ensure the health care provider signs the report on both pages and dates it. Include their contact information as required.
9. Sign the form yourself, acknowledging your permission for releasing immunization records to clinical facilities.
10. Once all sections are completed and verified, save any changes made to the form. You can then download, print, or share the completed report as needed.

Take the next step and complete your medical examination report online today!