Medical

Download any of the following medical forms below for free in Adobe PDF or Microsoft Word (.doc) formats. The forms are eligible for use in all 50 States and may be modified. Simply fill in on your computer or by hand after printing.

Forms

Non-Foreign Service Personnel

This form is designed to solicit an information necessary in making appropriate medical clearance decisions for non-foreign service personnel and their family members. Read carefully and understand fully all the questions or items asked in the form.

USA Boxing Athlete Physical Form

This certificate must be completed and signed by both a licensed physician and an athlete. An athlete guardian needs also to sign on it if an athlete is below 18 years of age. A physician certifies that an athlete is fit to participate in Boxing. If not fit, a physician needs to state disqualifying medical reasons.

Medical Reporting Form

The physician, person or agency can report an individual whose driving ability is questionable due to some physical or mental impairment. When completing this form, complete as much information stated therein.

DHS-3340-ENG 3-11 Minnesota Health Care Programs Asset Assessment for Medical Assistance (MA) Payment of Long-Term Care (LTC) Services

As a proof of your receipt of 30 uninterrupted days of long-term services, LTC services, fill out a legal form. It is called as “DHS-3340-ENG 3-11 Minnesota Health Care Programs Asset Assessment for Medical Assistance (MA)Payment of Long-Term Care (LTC) Services.”

Peri-operative DNR Suspension Form

This is the consent of the patient to temporarily suspend the existing Do-Not –Resuscitate orders.

N-648, Medical Certification for Disability Exceptions

As provided in the instructions for the use of Form N-648, the medical professional must conduct an in-person examination of the applicant. After which the license medical professional must certify this form,except the “Applicant Attestation and Interpreter’s Certification.”

Emergency Clinical Designation of a Surrogate

Any licensed physician must complete the Emergency Clinical Designation of a Surrogate form.

Notice of Advance Directive Revocation

The applicant must complete only if he or she intends to willfully, knowingly and voluntarily revoke in advance directive.

Notice of Health Care Agent/Proxy Resignation or Deferral

This Notice of Health Care Agent/Proxy Resignation or Deferral form must be completed by a health care agent or proxy making health care decisions for the principal. It is deferring his or her role.

Understanding the Georgia Living Will

A legal document that could be used to describe on how we wish to be treated during our death, postponing or delaying our death, is a living will. In Georgia, its law on a living will was first passed in 1984.