FREE 12+ Sample Medical Statement Forms in PDF | MS Word

The most important asset that each one of us possess is our health. Being healthy means not just being physically fit but also mentally, emotionally and spiritually. If you are not certain if you are healthy, try consulting your doctor or physician.

Ask for a medical statement form as a proof that you are capable of doing or joining any activities that requires a lot of work. With a medical statement form, you will also be able to identify or discover what are your limits in terms of keeping yourself safe an healthy.

Child Medical Statement Sample

Caregiver Medical Statement

Adult Medical Statement

Free Medical Statement

Medical Source Statement

What is a Medical Statement?

A medical statement is a formal and legal statement which contains medical records. All medical records are held confidential, in fact, physicians are not allowed for any release of these since these records are private and personal. A medical statement is often used and required when there are activities which have possible potential risks.

This statement is written on a medical statement form and is filled out by the authorized or licensed physician and the participant. A medical statement form is only permitted or valid if, and only if the signature of the physician and the participant is affixed as a declaration that all information indicated are true.

How to Fill Out a Medical Statement

The basic information that are found in a medical statement form are the following:

• the patient or participant information such as the name, address, date of birth, contact details and social security number
• the physician information such as the license number, name, position, address and contact details
• the list of diagnostic tests that were conducted or performed to the participant
• the signatures of the physician and participant as a declaration that all information provided are true and up to date

A statement is used in many ways which varies on different purposes. Another type of a statement form is an employee statement which falls on different topics. Few examples of employee statement forms are employee benefit statement, employee witness statement, and employee counseling statement.

Further example of a statement form is a financial statement form which is a composition of the balance sheet, income statement, and profit & loss statement.

Printable Medical Statement

Medical Condition Statement

Medical Impact Statement

Sample Medical Impact Statement

Supplemental Medical Statement of Facts

Medical History Statement

Medical Statement Form in Word Format

Importance and Purpose of the Medical Statement

A medical statement form contains the medical records of a patient or participant. This statement shows the concerns or health problems that are experienced by the patient, and the medication in treating them. The medical statement form is also used as a declaration that the participant of a certain activity is capable of joining basing on the results of the tests.

Physician or any health care personnel who is responsible for the release of medical statement of the participant is held liable to any disciplinary actions that punishable by law. Unless the participant fills out and submits a Medical Release Form.

A medical release form, also termed as medical claim form is a formal statement made by the patient or participant that authorizes the physician to release his or her medical records. This indicates that he/she is releasing any legal responsibilities and liabilities that may arise from the release of these confidential information. The possible reasons for the release are the following:

• someone else is going to pick up the results or records in behalf of the owner
• the medical center will be using the results for experimentation or evaluation