Medical examination report form

    • [DOCX File]FMCSA Medical Examiner Handbook

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      Apr 23, 2020 · The Medical Examination Report Form, MCSA-5875, set forth at 49 CFR 391.43(f), includes testing that must be completed as part of the physical qualification examination. Because the Medical Examination Report Form, MCSA-5875, is included in the FMCSRs, the information requested from both the driver and ME is required by regulation. Accordingly, th

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    • [DOC File]State of California - Commission on POST

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      MEDICAL EXAMINATION REPORT – Peace Officer. POST 2-253 (Rev 04/2018) Commission on . Peace Officer Standards and Training (POST) 860 Stillwater Road, Suite 100. West Sacramento, CA 95605-1630 SECTION 1. EXAMINATION FINDINGS 1. CANDIDATE’S NAME (LAST, FIRST, MI) 2. BIRTH DATE (MM/DD/YYYY) 3. SOCIAL SECURITY NUMBER . Last 4 digits: 4. SEX. M F 5.

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    • [DOCX File]Medical Examination Review

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      MEDICAL EXAMINATION REPORT. MV3644 (1) 10/2018 Ch. 343 Wis. Stats. & Trans. 112 Admin. Code. T583. Once completed, this form can be faxed, emailed or mailed to us at any of the addresses listed to the right. After we've reviewed this report, you may be required to file medical reports periodically.

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    • [DOC File]DHS-49, Medical Examination Report

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      Grantee Name (Client Name if not grantee) MEDICAL EXAMINATION REPORT State of Michigan Client ID Number Case Number Department of Human Services MALE FEMALE Date of Birth WORKER INSTRUCTIONS: ... Telephone Number 18. Date Form Completed ( ) AUTHORITY: P.A. 288 of 1988, P.A. 368 of 1996, or 42 CFR and 45 CFR.

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    • [DOC File]Medical Examination

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      Medical Examination Physician’s Name: Date of Evaluation Physician’s Address: Physician’s Phone # Person Receiving Examination: DOB Age Height: Temperature: Blood Pressure: Weight Head Circumference: General Appearance: Check Normal Abnormal Remarks 1. Head 2. Fontanelle 3. Skin 4. Lymph Nodes 5. Facies 6. Eyes a.

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    • [DOC File]SP4419 Medical Examination Report (Enforcement Cadet)

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      MEDICAL EXAMINATION REPORT. Wisconsin Department of Transportation. SP4419 9/2014. The Wisconsin Law Enforcement Standards Board, under LES 2.01(f)(1)(2), requires that a peace officer candidate be examined by a licensed physician or surgeon to ensure that the applicant is free of any physical defect or medical condition which might adversely affect job performance.

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    • [DOC File]GN-3130: Examining Physician's or Psychologist's Report ...

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      CONFIDENTIAL COURT FORM. GN-3130, 11/20 Examining Physician’s or Psychologist's Report (Adult Guardianship)§54.36, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Page 4 of 4. GN-3130, 11/20 Examining Physician’s or Psychologist's Report (Adult Guardianship)§54.36, Wisconsin Statutes

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    • [DOC File]PHYSICAL EXAMINATION REPORT/CERTIFICATE

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      The medical examination report shall be used only for determining the fitness of the seafarer for work and enhancing health care. DETAILS OF MEDICAL EXAMINATION (To be completed by examining physician; alternatively, the examining physician may attach a form similar or identical to the model provided in Appendix 1 of RMI MG-7-47-1).)

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    • [DOC File]Correctional Officer Hiring Process - North Carolina

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      Form F-2 Medical Examination Report (blank for completion by physician) Essential Job Functions (blank for completion by physician) Essential Training Functions (blank for completion by physician) Forms Checklist. CJ Certified Hiring Process New Application for Certification.

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    • [DOC File]UNITED NATIONS

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      UNIES EMPLOYMENT MEDICAL. REVIEW QUESTIONNAIRE This questionnaire is used to evaluate the health status of new recruits and current employees who require medical clearance in accordance with ST/AI/2011/3. Based on the responses further medical evaluation may be required.

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