FREE 30+ Sample Medical Clearance Forms in PDF | MS Word

Physicians, pharmacists, and even the medical staff are responsible for their patients’ safety. They must assure that the medicine, as well as the medical machines that the patient will be using are recommended by a licensed physician for curing his illness, and not merely due to his own perception. This specific situation needs the representation of a medical clearance form signed by the physician and agreed by the patient himself.

A medical clearance form is used whenever there is a need to re-assess an individual before he will be permitted to undergo a medical procedure or to take a medication. The form has the basic information of the individual, the name of the physician, a list of the individual’s illness or medical condition as well as the type of activity or procedure that he will be engaging soon. The physician should state whether he will grant an approval for the individual or not, which will be accompanied by the vital reasons of the declination.

Blank Medical Clearance Form

When to Use a Medical Clearance Form?

A medical clearance form is not only used within the premises of hospitals and medical clinics but also in various agencies and organizations. The following are some of the instances when this document will be of great use:

Travelling to Faraway Destinations

Travel agencies in the land, water, and air will use a medical clearance as a tool in determining the health and medical needs of their passengers. This document is also essential in distinguishing if the passenger passed the travel qualifications of the agency such as their standard for the medical equipment of the passenger or the required travel consent to be presented by a minor in need of an overseas medical treatment. This form should be given to the travel authority as part of the travel medical requirements and paperwork of an individual. Additionally, it must be completely filled out before it heads out to the submission phase of the travel agency’s travel procedures.

Enrolling and Applying

Bringing a resume in a job application and the payment of the tuition fee in a school registration may not be the only materials that an applicant will need. Due to the need of educational institutions to have the health background of their students, faculty members and staff, they demand a medical clearance form from these people.

The medical clearance will state the boundaries and the limitations of a student as well as aid the faculty members in providing the appropriate lessons and strategies for him to effectively learn. On the other hand, a medical clearance is needed in the field of employment to allow the employers in acknowledging the employees or the applicants who may need special medical needs to be catered by the company.

Enrolment Medical Clearance Form

Incoming Student Medical Clearance

University Medical Clearance Form

Participating in Competitions

Regardless if a competition focuses on sports or entertainment, medical clearances must be part of the essentials to be requested by the event planner and organizers. For these instances, the medical clearance will inform the organizers about the physical and mental capabilities of the participant. It is vital that the strength levels and the ability of the participant to handle the pressures in the contest are highlighted on the form to let the organizers construct a preventive action plan to deal with injuries in the midst of the event.

Undergoing a Surgery

Before anyone is allowed to proceed for a surgical procedure, the surgeon needs to assure that his patient will be capable in dealing with the possible complications and risks of the surgery. Additionally, an area of the clearance also focuses on conducting a physical assessment of the patient to aid the surgeon in gathering data about the patient’s health issues and concerns. This will omit the surgeon in performing a surgery which may put the patient’s health condition in danger.

Community Medical Clearance Form

Admission Medical Clearance Form

What Is a Medical Clearance Request Form?

A signed medical clearance acts as a document which certifies an individual about his medical state. However, before this form will be given, the agency who required the representation of the form must send a request form to their trusted physician. The medical clearance request form may have an attached formal letter that informs the physician about the intention of the agency with regards to requesting an assessment for the patient.

This form has the general information of the patient, his insurance details, and the kinds of laboratory examinations that the patient will undergo to acquire the clearance. The bottom of the form also states the other clearances that the patient may need such as a cardiac and renal clearance.

Medical Clearance Request Form?

Types of Medical Clearance Forms

Medical clearance forms have numerous varieties which can be used by different individuals depending on where they will submit the document. Listed below are the known samples of medical clearance forms:

Medical Clearance Form for Surgery – If an individual is subjected to imprisonment, he needs to undergo a medical examination first before he will be sent behind the bars. With the aid of an incarceration medical clearance form, the physician will be able to state the condition of the detainee which can either send him to jail or let him face a house and hospital arrest depending on his issues. A section of the form is allotted for the specific rights of the patient and the government in protecting the patient’s information as well as requesting for the patient’s consent before his details will be used by outside parties.

Medical Clearance Form for Surgery

Medical Clearance Examination Form – This is used in categorizing whether a child or a participant is eligible for doing a particular activity. The level of the medical examination to be granted for the participant will depend on the type of activity which he will be joining. For instance, if a participant will be playing for football, he may undergo a thorough physical and strength test to assure that he will be able to play safely during the games. The participant’s allergies, and the doctor’s notes or remarks are two significant parts of the form which can inform the game organizers about the meals that they may avoid to serve for the participant and to allow them in preparing the necessary medications in the event of an emergency.

Medical Clearance Examination Form

Health & Medical Clearance Form – This is often used for applying as a tenant in a school dormitory. The form is essential to assure that the dormitory will not be catering tenants who are sickly and will need ample medical treatment. Sections of the form include a student information section, student’s medical history and a statement of a privacy policy.

Health and Medical Clearance Form

Physical Evaluation Medical Clearance Form – A physical and health evaluation will be conducted for individuals who will apply for a job which requires physical strength such as dealing with large cargo and stock deliveries. A physical evaluation medical clearance form contains a letter designated for the physician which has the details of the tests, obstacle and lifting courses to be taken by the individual.

The physician needs to state the individual’s muscular restrictions, cardiovascular risk factors, and possible artery diseases to allow the agency in determining whether they will decline the job application, or hire the applicant and assign him in an area where the disease will not be triggered.

Physical Evaluation Medical Clearance

Confidential Medical Clearance Form – Airline companies deal with various people from different countries and races every single day. With this, they should make sure that their passengers and the staff are safe from contagious diseases and medical risks. An airline medical clearance form will be used for this specific purpose of gathering the medical information of the probable passengers of a flight. By having the form, the airline’s medical officers will be able to assess as to whether a passenger is deemed as fit for traveling or if the passenger will need an escort in the duration of the airtime travel.

Confidential Medical Clearance Form

Student Medical Clearance Form – Most educational institutions conduct a medical test for their students during the period of enrollment due to the requirement of the state when it comes to the students’ welfare. With this, a student medical clearance form will be requested and used for the medical information of the students.

The school’s clinician and the student are the parties who must complete the fields on the form. The student will then have to affix his or her signature on the form to signify that he or she had successfully undergone the test, and the statement forms or the answers on the document are facts, and that he or she is aware on every bit of information indicated on the clearance form.

Student Medical Clearance Form

High School Medical Clearance Form – High school students are known as active individuals who play varieties of sports and engage in all the possible scholastic activities available in their educational institution. Aside from the aforementioned student medical clearance form, a high school medical clearance form can also be used for students who are specifically in the secondary education levels. This form is also expected to be used by the team physician in a sports organization, if the intention of having the form is to collect data about a team player’s medical history and background.

High School Medical Clearance Form

College Program Medical Clearance Form – Colleges and universities promote numerous courses with varying standards per course such as a grade-scale and height requirement for the students. The college program medical clearance form will simply outline the student’s ability in passing the required medical tests and examinations for enrolling in his or her chosen course. The healthcare provider who has conducted the medical procedure for the student will state his or her identity information such as his or her name, his or her associated medical agency, their address and his or her signature.

College Program Medical Clearance Form

Readmission Application Medical Clearance Form – This form is used by students who left or dropped out from an educational institution and wanted to enroll again in the upcoming semester. The intention of this form is to gather the details of the student such as his contact information and to send a request to the school administration that will allow him in acquiring a medical clearance examination for the school application process of the institution.

The reasons why the student had left the campus is also another requirement which is expected to be stated on the form along with the specific educational level attained by the student before his or her leave.

Readmission Medical Application Clearance

Athlete Training Medical Clearance Form – The emergency information and the immunization report of the student are vital sections of this form which is to be filled out by the student himself. The succeeding page of the form will be allotted for the use of the student’s physician. It will state a set of instructions to be followed by the physician with regards to how he may complete the form and how he will conduct the tests. The results of the physician’s data collection are included on the form to determine the student’s emotional and physical state.

Athlete Training Medical Clearance Form

Sports Class Medical Clearance Form – Participating in sports events, classes, and activities will require any participant to be physically, mentally, and emotionally stable to avoid obtaining possible injuries and accidents. A participant should indicate his or her general details like his or her home address, campus address and his  or her contact numbers on the form.

Additionally, the participant must state on the form as to what class he or she is interested in joining, and he or she must answer the questionnaire on the form. A waiver of liability is on the bottom of the form which is essential for indicating the awareness of the participant and for declaring the participant’s responsibility for himself during the class sessions.

Sports Medical Clearance Form

Standard Driver Medical Clearance Form – Boat racing competitions are common in some countries, and it is often considered as a type of sports activity. This, however, will recommend boat racers to be physically active and healthy to assure that they will not be breaking their bones during the competition.

In the case that a boat racing competitor has been in a past injury, he needs to provide a proof to the competition event planner and organizers that he is physically stable before and during the race with the representation of a current medical certificate supplied after a medical clearance exam will be conducted. The boat medical clearance form is used by doctors to certify that the competitor is indeed qualified for the race.

Standard Medical Clearance Form

Massage Medical Clearance Form – Massage therapists are people who provide soothing and calming touches that heal the aching body parts of any human being. These therapists often undergo a session and class that teaches them massage styles and patterns.

However, before they will be accepted in a massage therapy college institution, they need to successfully go through a series of medical exams as an assurance that they will not be the source of communicable diseases in the school. The form has three main sections which are for the patient’s physical health information, mental health, and indications whether the patient or the applicant has a communicable illness.

Massage Medical Clearance Form

Volunteer Medical Clearance Form – Individuals who want to do volunteer work in a medical institution are required to take a medical exam as part of the required volunteer application process before they will be granted with an approval. A volunteer medical clearance is used to list the results of the screening and number of vaccines undergone by the volunteer. It will also have the signature of the medical professional who is responsible for the volunteer’s medical tests as well as his or her license number to supply a proof that he or she is a licensed and registered medical practitioner.

Volunteer Medical Clearance Form

Non-Hospital Employee Medical Clearance Form – This document acts similarly to a security authorization which allows the holder to access areas which are granted permission for him. However, it focuses on the hospital premises and medical records rather than confidential papers of the government. The immunization history and the name of the sponsoring department who will attest the certification of the clearance holder will also be stated on the form to indicate who will be accountable for the actions of the holder. Significantly, the medical clearance access must only be given to those who have an important intention in the medical institute and not to anyone who will only use it for nonsense purposes.

Non-Hospital Employee Medical Clearance

Staff Medical Clearance Form – Companies and organizations who will conduct a summer camp or activity for children will need this form for their staff and personnel. The form will have a letter of introduction which aids the healthcare provider in determining what medical test he will be administering to the staff of the organization.

The physician’s medical report will be found on the form which will simply indicate his decision of whether he will allow or disallow the staff to provide a service in the camp. If the physician’s verdict about the test results of the staff is to not grant an approval, he needs to state the reasons for his decision such as a known illness or disability.

Staff Medical Clearance Form

Medical Physical Clearance Form – Police officers and security personnel also undergo an in-depth medical examination procedure before they are granted with a position. The main intention of having the exam is to gather a measurement of the fitness and physical abilities of the applicant, and determine if he fits with the qualifications for the position that he is applying. The form can also be used for granting a health risk assessment for the applicant to allow the employer or the police agency in acknowledging the varying risk levels of each applicant to the activities that they may conduct.

Medical Physical Clearance Form

Client Medical Clearance Form – Fitness and exercise programs can either help in curing an existing medical illness or cause it to become severe. This is why a client medical clearance is often requested to be submitted before a fitness client will be allowed to participate in the exercise. The form is mainly composed of a letter which is addressed to the physician that will state the exercises the client will be participating. It also contains the client’s and the administering physician’s contact information which are necessary to enable the fitness organization in reaching out to both parties at any possible time.

Client Medical Clearance Form

Worker Medical Clearance Form – People who work for public safety and who deal with tasks which are physically challenging are required to take varieties of health and medical check-ups to assure that they are capable for their job. By presenting a completed worker medical clearance form to the employer, the applicant or the worker is indicating that he has done the physical assessment or fitness indicator test and that the physician has stated the outcome on the form.

Physician Medical Clearance Form

Candidate Medical Clearance Form – This form is essentially for individuals who are candidates for a particular job position wherein the physical strength is a mandatory requirement such as a firefighter or a head officer. The form is accompanied by a health questionnaire to be answered by the applicant or the job candidate which is the first step and a way to determine if there is a need for a medical clearance to be requested for a candidate’s illness. The candidate is expected to state facts based on his or her known medical status to assure that medications are prepared in events of immediate need and also to avoid having the candidate face grave danger due to the undisclosed medical information.

Candidate Medical Clearance Form

The physician may also state a few comments and recommendations for both his or her patient and the organization who requested the medical examination and clearance certification. Although the opinion of the physician is essential, the final verdict of whether a job applicant will get hired, or a student will be allowed to join an activity will still be upon the regulating organization regardless of the physician’s choice.

Fitness Class Medical Clearance Form

School Medical Clearance Form

Medical Practitioner Clearance Form

Basic Medical Clearance Form

Lastly, the medical clearance certification form must be up to date in order to acquire an assurance that the medical status and condition of the holder is recorded in events of a change due to an evident illness or disease. This also allows all the parties to be thoroughly informed about the condition of the certificate holder, and limit the levels of physical activities to avoid complicating his or her situation.