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Certificate of medical exmination form 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin with Part A, where you will enter your personal information. Fill in your name, social security number, sex, and date of birth. Ensure accuracy as this information is crucial.
- Indicate if you have any medical disorders that may affect your job performance by selecting 'YES' or 'NO'. If 'YES', provide a detailed explanation for the examining physician.
- In Part B, the appointing officer will specify the purpose of the examination and position title. They should also describe job requirements and circle relevant functional and environmental factors.
- Finally, Part C is for the examining physician to complete. They will document their findings and sign off on the examination. Make sure all sections are filled out before submitting.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 1969 | 4.7 Satisfied (63 Votes) |
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This form is used to collect medical information about contained on this examination form and all other forms generated as a direct result of my examination.