15 Medical Information Forms

When you apply to some organization or any competition, there are some requirements that you will be needing to comply. One of those requirements is your medical clearance. The reason for this is in order for the business management to make sure that you have a clear record of your health and in making sure that you are perfectly healthy or with a normal condition; the risk or chances for the occurrence of some incidents or accidents are reduced or, better yet, prevented.

Medical information forms are utilized basically as a reference, in order for you or the requesting person/people to be aware of your current state of condition. Technically, these forms show you the overall summary of the results from the medical assessments that were necessarily done. One way to keep track of your health is to have a regular checkup. Further on this article are few sample forms for medical information forms that you could refer to when you want to be kept updated with regards to your health. Take a look on each of these downloadable forms and know what and when to use them.

Emergency Medical Information Form

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  • PDF

Size: 104 KB

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Simple Medical Information Form

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  • PDF

Size: 8 KB

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Personal Medical Information Form

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  • PDF

Size: 51 KB

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Blank Medical Information Form

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  • PDF

Size: 29 KB

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These sample forms provided for you are confidential. Therefore, only those who are authorized or those who are given the authorization are the only ones who could have access of these forms. Unless, the record owner or holder gives his or her consent to release the medical information to the public. Otherwise, the hospital or the medical center are accountable for such release with the absence of consent.

If you would refer to the forms above, the required details to be provided in filling out the form are the general information, such as the following:

  • The patient’s or the record owner’s information
    • The full name
    • The date of birth and age
    • The residential address
    • The contact information such as the email address and phone number/s
    • Other information includes the height and weight
  • The medical information such as the following:
    • The medical condition/s (illnesses and/or diseases)
    • The specification of the allergies for food, medication, or environmental
    • The past and current surgeries together with the date of when it was done
    • The physician’s full name, specialty, address, and contact number/s
    • The name of the hospital preferred
    • The insurance information
  • The emergency contact information
    • The person’s full name
    • The relationship to the patient
    • The home and work phone numbers
  • The medications details which include the following:
    • The name of the medication
    • The dosage or strengths
    • The quantity needed to be taken within a specific date
    • The purpose, reason, recommendation letter, or special instructions given

In completing the form, there are some medical appraisals that need to be conducted. This appraisal includes the interrogation of few questions with regards to the documents that are often required to be attached. The reason for this is in order to have a better understanding of the records or results. Moreover, the attending physician or the doctor would often provide the health information when all the results are out. Thus, the date of when the form is filled out or when the records are requested should be indicated in the form as a basis. Furthermore, the signature verification of both the patient or record owner and the physician should be affixed in the form.

Athlete Medical Information Form

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  • DOC

Size: 20 KB

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Participants Medical Information Form

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  • PDF

Size: 312 KB

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Summer Camp Medical Information Form

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  • PDF

Size: 39 KB

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Athlete Medical Information Form

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  • PDF

Size: 211 KB

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These kinds of forms are utilized to indicate the current health condition of each individual athlete or participant. These forms serve as the basis or proof that each individual interested to join are capable of undertaking the different activities and training application set for the said event. To make sure of this, the past medical reports of each participant or athlete are often mandatory to be attached in the form. The purpose for this is to have a further medical assessment of the individual. Thus, further information that are often needed to be provided in finishing or completing the process are as follows:

The athlete’s personal information

  • The first name
  • The last name
  • The identification number
  • The date of birth
  • The gender
  • The complete residential address
  • The email address

These information regarding the athlete or participant are required for their identification. This is in order to better identify who they are. These information are also kept recorded in the event management’s files.

The parents’ or emergency contact information

  • The full name
  • The address(es)
  • The contact number(s) at home, at work, personal
  • The email address(es)

The parents’ information are mandatory for various of purposes such as to keep both of them updated or notified with the activities or competitions, as well as to have them informed when there are different circumstances in which their child or children is/are involved. In other words, these information could be used as references to know who to contact in case of any emergencies. If in case that both parents are unavailable for some reasons, there must be a copy of the legal guardian’s information and his or her relationship to the child or participant. This copy will serve as an alternate contact in case both parents cannot be reached at the times of any circumstances.

The medical information or health history of the participant:

  • The injuries, illnesses, allergies, and/or diseases (both past and current)
  • The details of the condition
  • The medications taken (past and current)
  • The recent immunizations received
  • The dates of when these immunizations are received

The reason for including the attachments of these medical records is in order for the management to be aware of the current state condition of each of their participants. And by means of knowing these, they will be able to avoid the things that might trigger the said disability as indicated in the information or disability report form. Or better yet, the management or the event organizer will not allow those who are and have been diagnosed with some disability.

One way to find out who among the participants are qualified to join the competitions or the said activities is that they have to set some standards or qualifications for those who are interested. Similar to when you are seeking for a job proposal, you are not hired if you do not pass the qualifications set by the company for you.

In addition to the medical information, the details of the family doctor should also be included. The reason for this is to have an easy access for medical aid and treatment. Therefore, the doctor’s general information such as the following below are needed to be provided:

  • The family doctor’s name
  • The doctor’s work contact number/s (both telephone and cell phone)
  • The doctor’s home and/or personal mobile number

These forms are often provided before the competition or any sports activities are conducted. This is in order to make sure that the management appraisal will not be held liable to any injuries. That is, if the contributing factor existed even before the competition or the activity started. Yet, if the injuries are found out to be the result or fault of the management, they are held accountable for it. Upon completing the form, there are some basic information that should be included. These information are the date of when the form is filled out and the signature of the participant or the person completing the form.

Medical Information for Fitness to Travel

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  • PDF

Size: 100 KB

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Passenger Medical Information Form

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  • PDF

Size: 214 KB

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Standard Medical Information Form

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  • PDF

Size: 214 KB

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Medical Information Form for Passengers

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  • PDF

Size: 360 KB

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These sample forms for medical information are pertained to an individual’s health when traveling. These forms are used as the basis to see if the passengers are in right condition before, during, and sometimes also after the travel or trip, and whether the individual is advisable to travel. Not only that, these forms are also utilized when there are some circumstances that are encountered during the flight or the trip. Thus, all information release with regards to what has happened are documented. Here are further information that are necessary to be provided:

  • The passenger’s personal information
  • The details or the itinerary of the flight or trip
  • The nature of implications or illnesses that were encountered
  • The actions taken to resolve the incident report
  • The intended escort and/or the attending physician’s details
  • The passenger’s declaration or medical consent

The reason why these kinds of forms are made mandatory is because the information documented in these increase the awareness of the people on board, most especially the airlines’ staff. By means of this, proper care and medication will be provided to those who are in need, particularly those who have some disabilities. Those passengers who need attention during the trip may submit their disability report upon their reservation for their trip so that the management will be aware ahead of time.

Student Medical Information Form

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  • PDF

Size: 116 KB

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Basic Medical Information Form

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  • DOC

Size: 7 KB

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Disabled Student Medical Information

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  • PDF

Size: 238 KB

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In summing it all up, medical information forms are basically used as the basis of the current health state of condition of an individual. These could be used as a reference in order for the applicant or participant to be qualified with the physical standards set by the management or organizers. Otherwise, the application of those who are diagnosed with some mental or physical health limitations are rejected.

The reason for making sure that each and every applicant is qualified to the medical release standards is to ensure their safety. And it is not that the management are getting their hands off of it, but it is because they do not want anything to happen to their players, athletes, or participants. Another way to make sure of this is for the management to provide a form for release of liabilities or waiver forms. Though the management releases any of it, they are still held responsible and accountable for whatever happens.

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