Physician Certification - 420exam.com 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's last name, first name, and date of birth in the designated fields.
3. Indicate whether the patient is homebound by selecting 'Yes' or 'No'.
4. In section 6a, select the chronic medical condition that applies to the patient from the provided list.
5. If applicable, specify the etiology of the condition in section 6b.
6. For plant count recommendations, fill in section 7a with either the standard amount or an increased amount as needed.
7. Provide a reason for any increased plant count in section 7b.
8. Complete the physician's information by filling out your license number, last name, first name, mailing address, city, state (CO), zip code, telephone number, fax number, and email address.
9. Finally, sign and date the form in the Physician Attestation section to certify your assessment.

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