Pre Employment Physical Form 01-21-11 - H&C Nursing Care 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information at the top of the form, including your name, address, telephone number, gender, date of birth, and last four digits of your Social Security number.
3. Next, have your medical practitioner complete the required health metrics such as height, weight, blood pressure (BP), and temperature/pulse/respiration (T.P.R).
4. Fill out the immunizations and lab tests section. Indicate results for PPD tests and provide dates for implantation and reading. If applicable, include details for chest X-rays and other vaccinations.
5. Complete the Review of Systems section by checking any relevant symptoms or conditions that apply to you.
6. If you are currently taking medications, indicate this in the Present Medication(s) section and attach a list if necessary.
7. Finally, ensure that your medical practitioner signs and stamps the form before submission to confirm its validity.

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