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How do I fill this out?
To fill out this form, start by providing personal information such as name, height, and weight. Next, ensure the physician conducts a clinical evaluation and documents any findings. Finally, confirm the health care provider completes and signs the form before submission.
How to fill out the ST. Thomas University Physical Examination Form?
1
Provide your personal details at the top of the form.
2
Have your physician perform a complete clinical evaluation.
3
Document any surgical procedures or medical conditions.
4
Ensure your health care provider signs the form.
5
Submit the completed form as per the provided instructions.
Who needs the ST. Thomas University Physical Examination Form?
1
Incoming students requiring a physical exam for enrollment.
2
Athletes needing clearance to participate in college sports.
3
Students applying for health insurance requiring documentation.
4
Students with medical conditions needing detailed evaluations.
5
Individuals needing a generalized health assessment for college activities.
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What are the instructions for submitting this form?
Completed forms should be submitted via email to healthservices@stthomas.edu or faxed to 123-456-7890. You may also submit the form physically at the health office located at 123 University Avenue, Minneapolis, MN 55403. Ensure that all required signatures are obtained before submission.
What are the important dates for this form in 2024 and 2025?
The physical examination form must be completed before the start of the academic year, with deadlines in July for Fall admissions and December for Spring admissions. Ensure all medical evaluations are conducted and documented by the physician prior to these dates.
What is the purpose of this form?
The purpose of this physical examination form is to ensure that students at ST. Thomas University meet the health requirements for participation in college activities. It serves as a medical assessment tool to identify any health concerns that could affect a student’s educational experience. Additionally, it provides necessary documentation for health insurance and sports participation.
Tell me about this form and its components and fields line-by-line.
- 1. Name: The full name of the student undergoing the physical examination.
- 2. Height: The height of the student recorded in centimeters or inches.
- 3. Weight: The weight of the student in pounds or kilograms.
- 4. B/P: Blood pressure reading taken during the examination.
- 5. Vision: Vision test results for both right and left eye.
- 6. Date of exam: The date on which the physical examination was conducted.
- 7. Pulse: Pulse rate of the student at the time of examination.
- 8. TB Test Date Done: The date when the Tuberculosis test was performed.
- 9. Results: The results of the Tuberculosis test.
- 10. Clinical Evaluation: Checklists for evaluating various body parts and systems.
- 11. Physician Comments: Any additional notes or comments from the physician.
- 12. Limitations/Rehabilitation needs: Details of any medical limitations or needs for rehabilitation.
- 13. Allergies: Any listed allergies to medications.
- 14. Health Care Provider Signature: Signature of the physician completing the evaluation.
- 15. Health Care Provider Name: Name of the physician or healthcare provider.
- 16. Address: Business address of the healthcare provider.
- 17. Date: The date the form was signed by the healthcare provider.
- 18. Phone Number: Contact number of the healthcare provider.
What happens if I fail to submit this form?
Failure to submit this form may result in the inability to participate in college functions or sports activities. Additionally, it could delay the processing of health insurance benefits.
- Participation Issues: Students might be restricted from participating in sports or other activities.
- Enrollment Delays: Late submissions could lead to enrollment issues or delays.
- Health Consultations: Required health consultations might be postponed or unavailable.
How do I know when to use this form?
- 1. New Student Enrollment: Incoming students must complete this form for health assessment.
- 2. Athletic Participation: Athletes require this documentation to compete in sports.
- 3. Health Insurance Documentation: Students need this form for health insurance verification and documentation.
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