Medical Form Checklist:
- Made an appointment with your
physician for a physical examination?
- Completed all asterisked areas on
both sides of the Personnel health
- Remembered to bring the form with
you to the physician at the time of your appointment?
- Made arrangements to return the
completed form to the school nurse?
Has Your Physician:
- Remembered to complete all medical
information areas of the Personnel Health Form?
- Submitted documentation of
- If immunization record not
available/ infectious diseases blood titres, Rubella, measles, mumps.
- Administered the P.P.D. Mantoux
(T.B. test) test? (Nurse or M.D. reads results in 48-72 hours.)
- Tetanus toxoid booster within past
- Signed and dated the back of the