Tate Zip License Number (if, licensed) License Type: 2 Physician TO BE FILLED IN BY EXAMINING PHYSICIAN (Please print) Name of Physician Address of Physician City State Physician’s Signature Zip Date __________________________________________ _________________________________________ 3 General Health Assessment Fitness is being physically and mentally capable of undertaking the tasks that an individual is required to carry out and is licensed to engage in by the NYC Depar.
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How to fill out the NY LIC62 online
The NY LIC62 is a physical examination form that applicants must complete before submission. This guide offers a step-by-step approach to ensure you fill out the form accurately and efficiently online.
Follow the steps to complete the NY LIC62 form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill out the applicant information section, which includes your first name, last name, date of birth, social security number, home address, phone number, city, state, zip code, license number (if licensed), and license type.
- Proceed to the physician section. This part must be completed by the examining physician, which includes their name, address, city, state, signature, zip code, and date.
- In the general health assessment section, read through the definitions of physical and mental fitness required for the applicant based on NYC Department of Buildings licensing criteria.
- Instruct the examining physician to indicate the fitness status by selecting one of the options: medically fit, medically fit with accommodations (attach Accommodation Statement), or not medically fit.
- The physician must also provide their examination address, date of examination, name, signature, and stamp.
- As the applicant, sign the form authorizing the release of the information to the licensing authority.
- Once all fields are filled out, review the form for accuracy. You can then save changes, download, print, or share the completed form as needed.
Complete your online application efficiently by filling out the NY LIC62 form today.
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