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Click ‘Get Form’ to open the health district clearance form in the editor.
Begin by entering the property tax account number and site address in the designated fields. Ensure accuracy as this information is crucial for processing your request.
Fill in the PDS plan check number, city, and compliance requirements regarding GMA. Indicate whether expedited review is needed.
Provide details about the owner, including name, phone number, email, and mailing address. This ensures that all communications are directed appropriately.
Indicate if a septic system is installed or proposed. If existing, note the year of installation and answer whether an onsite sewage disposal application has been submitted.
Specify the source of water supply and confirm if an application has been made for it as well. This section is vital for ensuring compliance with health regulations.
Describe your building project clearly, including its intended use (e.g., SFR, addition).
Complete any additional requirements such as providing a scaled plot plan depicting necessary features like property lines and septic system components.
Finally, sign and date the application at the bottom before submitting it through our platform for processing.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (75 Votes)
2018	4.3 Satisfied (58 Votes)
2016	4.4 Satisfied (207 Votes)
2011	4 Satisfied (47 Votes)
2009	4 Satisfied (34 Votes)

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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 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 do you need for a medical clearance?

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.