Health & Medical Clearance Form 2026

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  1. Click ‘Get Form’ to open the Health & Medical Clearance Form in our editor.
  2. Begin by entering your Student Information, including your Name, Date of Birth, and Sex. Ensure accuracy as this information is crucial for your health records.
  3. Next, move to the Required Immunizations section. Fill in the dates for each dose of immunization received or indicate immunity results if applicable. Be thorough to avoid any delays in processing.
  4. Complete the Tuberculosis Screening section by providing results from a recent test. If positive, include details about the chest X-ray and its results.
  5. In the Medical History section, list any main present illnesses or conditions such as allergies or medications that may affect your health status.
  6. Finally, ensure that your Health Care Provider fills out their verification details, including their name, signature, and contact information before submitting the form.

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Basic Evaluations: Without tests, it may take up to 12 days. Comprehensive Clearances: If lab tests or imaging studies are required, may take several days.
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.
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.
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.
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