Medical clearance request form 2026

1. Click ‘Get Form’ to open the medical clearance request form in the editor.
2. Begin by filling out the 'Applicant/Licensee Information' section. Enter the facility/home name, license number, and address details accurately.
3. In the 'Patient Information' section, provide the patient's full name, date of birth, telephone number, and address. Ensure all information is printed clearly.
4. Complete the 'Release of Information' section by signing and dating it. This authorizes the release of medical information to relevant authorities.
5. The physician must fill out the 'Medical Information' section. They should answer questions regarding TB testing and provide insights into the patient’s physical and mental health condition.
6. Finally, ensure that both the physician's signature and date are included at the end of the form before submitting it through our platform.

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