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EMPLOYEE HEALTH EXAMINATION RECORD - printablep1nnaclecom

EMPLOYEE HEALTH EXAMINATION RECORD - printablep1nnaclecom 2025

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The document is an Employee Health Examination Record that collects personal and medical information from employees, including emergency contact details and a checklist of past health issues. It includes a section for a physician's examination results and emphasizes the importance of honesty in reporting health conditions, with potential consequences for misrepresentation. Additionally, it outlines protections under the Genetic Information Nondiscrimination Act of 2008 regarding discrimination based on genetic information.

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Click ‘Get Form’ to open the EMPLOYEE HEALTH EXAMINATION RECORD in the editor.
Begin by entering your name and marital status in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in your date of birth (DOB) and emergency contact details, including their name, relationship, address, and telephone number.
Review the health history section carefully. Circle 'Yes' or 'No' for each condition listed, such as diabetes or heart trouble. This section is vital for assessing your health status.
Sign the declaration statement confirming that all provided information is accurate. This signature is essential for validating your health examination record.
Complete the physician's examination section by providing details about various health aspects like ears, eyes, and blood pressure. Ensure that this part is filled out by a qualified physician.
Finally, review all entries for completeness before saving or printing your document directly from our platform.

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