This document is a health examination record form containing information about an employee's physical exam. It includes sections to record data about the employee's respiratory system, circulatory system, digestive system, genitourinary system, skin, locomotor system, nervous system, eyes, vision, nose, ears, hearing, throat, teeth and gums, immunizations, and any remarks or recommendations. The form is signed by both the employee and examining physician.
Original Description:
Original Title
Teachers' Health Examination Card (CS Form 86)
This document is a health examination record form containing information about an employee's physical exam. It includes sections to record data about the employee's respiratory system, circulatory system, digestive system, genitourinary system, skin, locomotor system, nervous system, eyes, vision, nose, ears, hearing, throat, teeth and gums, immunizations, and any remarks or recommendations. The form is signed by both the employee and examining physician.
This document is a health examination record form containing information about an employee's physical exam. It includes sections to record data about the employee's respiratory system, circulatory system, digestive system, genitourinary system, skin, locomotor system, nervous system, eyes, vision, nose, ears, hearing, throat, teeth and gums, immunizations, and any remarks or recommendations. The form is signed by both the employee and examining physician.