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Health clearance form 2025

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The document is a Health Clearance Form for students at the University of Hawai’i - Leeward Community College, outlining the requirements for tuberculosis (TB) and measles, mumps, rubella (MMR) vaccinations. It specifies that health clearances must be completed by a licensed medical professional and submitted to the Health Center before registration. The form includes sections for personal information, TB clearance details, MMR vaccination proof, and physician documentation.

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Click ‘Get Form’ to open the health clearance form in the editor.
Begin by entering your personal information, including your name, UH ID, mailing address, email address, daytime phone number, and birthdate. Ensure all details are accurate for proper identification.
For tuberculosis clearance, provide the required dates and results of your TB skin test or chest x-ray. Make sure this information is dated within one year of the semester start date.
Next, complete the measles, mumps, rubella (MMR) section. Indicate proof of immunizations or provide documentation from a physician if applicable. Include dates and results as necessary.
Finally, ensure that a licensed medical professional completes their section with their printed name, signature, and contact information before submitting the form.

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What is a healthcare clearance form?

A Medical Clearance Form is a document that certifies an individuals medical fitness for a particular activity or procedure. It usually includes a health history review, physical examination, and medical tests to ensure the patient is healthy enough to participate in the activity or undergo the procedure.

What is a health verification form?

A medical insurance verification form is used by healthcare providers to verify a patients health insurance. It helps determine what services will and will not be covered by the insurance provider.

What requires medical clearance?

Whether youre preparing for outpatient orthopedic surgery, a dental procedure under anesthesia, or elective care like cosmetic surgery, your care team will likely require a pre-operative evaluation. Medical clearance ensures your body is healthy enough to safely undergo anesthesia and surgery.

What is the purpose of a medical clearance?

Obtain Physical Examination: Obtain a physical exam for you and any accompanying EFMs from a licensed provider (i.e., a Physician Assistant, Nurse Practitioner, Doctor of Medicine, or Doctor of Osteopathic Medicine), who must complete and sign the DS-1843 /DS-1622 forms.

What is a clearance letter from the doctor?

A medical clearance letter confirms that you are fit to return to work, travel, or participate in activities.