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DOD Standard Form 78 1969-2023 free printable template
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TO BE GIVEN TO PERSON EXAMINED WITH A READDRESSED CONFIDENTIAL-MEDICAL” ENVELOPE. UNITED STATES CIVIL SERVICE COMMISSION CERTIFICATE OF MEDICAL EXAMINATION Form Approved Budget Bureau No. 50-R0073
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How to fill out certificate of medical exmination

How to fill out certificate of medical examination:
01
Obtain the necessary form: Contact the appropriate authority or organization to obtain the specific certificate of medical examination form required.
02
Provide personal information: Fill in your full name, date of birth, and contact information accurately.
03
Complete medical history: Provide details about your medical history, including any past illnesses, surgeries, or ongoing medical conditions.
04
Answer lifestyle questions: Fill in questions related to your lifestyle, such as smoking, alcohol consumption, and exercise habits.
05
Immunization records: Include information on your immunization history, including dates and types of vaccines received.
06
Provide a list of medications: List any medications you are currently taking, including dosage and frequency.
07
Undergo medical tests: Some certificate of medical examination forms require specific medical tests to be conducted, such as blood tests, urine analysis, or imaging studies. If applicable, schedule and complete these tests before filling out the form.
08
Signature and date: Sign and date the completed form to certify that the information provided is accurate.
09
Submit the form: Submit the completed certificate of medical examination to the relevant authority or organization for further processing.
Who needs a certificate of medical examination:
01
Individuals applying for employment in certain fields: Some professions, such as aviation, maritime, law enforcement, and healthcare, may require individuals to undergo a medical examination and provide a certificate to ensure their fitness for the job.
02
Student athletes: Athletes participating in school or collegiate sports programs may need to present a certificate of medical examination to ensure they are physically capable of participating safely.
03
Immigration purposes: In some cases, individuals applying for immigration or visa processes may be required to submit a certificate of medical examination as part of the application process.
04
Legal proceedings: In certain legal cases, court orders or legal requirements may necessitate individuals to undergo a medical examination and provide a certificate as evidence.
Note: The specific requirements for a certificate of medical examination may vary depending on the country, organization, or purpose for which it is needed. It is always advisable to consult the relevant authority or organization for accurate guidelines and instructions.
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