Examples of Personal physician in a sentence
Personal physician notes (may not be from a relative) or a note from SUNY Downstate Office of Student Health Service must be presented to the course coordinator to document excused absences for illness.
Obtains employment packet with the following documentation:• I9• W4• DE4• City of San Jose opt out form (only in San Jose)• Confidentiality Agreement (SCD 197)• Personal physician form• “Client Emergency Contact Card” (SCD 2529) form• Social Security card• Photo identification• Sick leave form2.
Personal physician includes any physician with whom the patient has an established relationship.
Personal physician for each proposed insured (if none, enter ”None”) Proposed Insured Physician AddressCity, State7.
Pre-participation Physical Evaluation Our Lady of Mount Carmel Date of Exam: Sport(s): Name: Sex: _ Age: Date of Birth: Address: Grade: Personal physician: Phone: _ OLMC PRE-PARTICIPATION PHYSICAL EVALUATIONName: Birthdate: Height: Weight: %Body fat (optional): Pulse: BP: _/ _Vision: R 20/ L20/ Corrected: Y N Pupils: Equal Unequal Risk behaviors discussed: Y N (diet, weight, driving, drugs, alcohol, sexuality, safety, stress)Please choose one of the following four (4) options:l.