Physician statement of good health form 2026

1. Click ‘Get Form’ to open the physician statement of good health form in the editor.
2. Begin by entering the individual's name, telephone number, address, apartment number, city, state, date of birth, social security number, and zip code in the designated fields.
3. In the 'Date of Examination' section, input the date when the examination took place.
4. Fill out the results of the examination. Indicate whether the individual is in reasonable good health and if they are at risk for transmitting communicable diseases.
5. If applicable, complete the Mautaux (PPD) section by entering the date given and results. If positive, include the chest x-ray date.
6. Finally, have the physician or ARNP sign and date the form. Ensure that their name, telephone number, address, city, state, and zip code are accurately filled out.

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