8+ Medical Clearance Request Form Templates in PDF

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Official authorization for conducting something or to proceed with something in any medical facility is known as medical clearance. This is generally done with the help of a form that is requested by one healthcare provider from another healthcare provider before providing any kind of treatment or before involving a patient in an activity. Make a medical clearance request form with the help of our form templates that can be used to determine whether the treatment or activity can affect the condition of the patient or, the other way round, i.e if the patient’s condition could affect the treatment or activity.

5 Steps to Create a Medical Clearance Request Form

Step 1: Basic Details

The first step to make a medical clearance request form is to provide the basic details of the patient who is requesting for the medical clearance. It will help in determining who the patient is, the date and time when he/she was admitted to the hospital along with the discharge date as well. The details will also include the address of the medical facility.

Step 2: Release Information

Make a list of the type of information, tests, scans, results, images, etc. that has to be shared. It is up to the patient to limit the type of information they want to be released and also mention why their healthcare information is being released. It has to be authorized by the patient that it is his/her wish to share their healthcare information for a particular reason.

Step 3: Medical Information

The medical information must be filled by the physician or the healthcare provider about the medical condition of the patient. This information will include whether the patient is fit to leave and that he/she can join in any other program or get hired for any kind of job.

Step 4: Comments By the Physician/Doctor

This step is also meant for the particular physician who can provide certain comments on the medical condition of the patient and also refer to some medical concerns or ask the patient to take further precautions for certain conditions that may arise in the future. They may also give some suggestions to the patient.

Step 5: Signature

End your medical clearance request form with a signature field and date. With this, your form will be ready for use. You can save a copy for yourself for further purposes.

8+ Medical Clearance Request Form Templates

1. Medical Clearance Request Form Template

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  • PDF

Size: 15.0 KB

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Do you want to make a medical clearance request forms in Word format for a patient who wants to join an exercising program? If yes, then no need to worry about producing a form from scratch. You can take the help of this medical clearance request form template and make a formal request from the healthcare provider of that particular patient asking them whether the patient can join the exercise program or not. Avail it now.

2. Medical Clearance Request Application Form Example

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  • PDF

Size: 126.9 KB

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Are you about to take re-admission to a university after your medical leave? Then you’re going to need an application form requesting for medical clearance. This example template might help you produce a well-written medical clearance request application as it deals with the important information that has to be included in the application form. You can make your application in any format, and if you are an Ipad user, you can go through our form templates in Pages for more options.

3. Sample Medical Clearance Request Form in PDF

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  • PDF

Size: 4.5 KB

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Is one of your patients prepping up for starting a training program just after medical treatment? If yes, then you will need a medical clearance form. Utilize this sample medical clearance request form template in PDF format and you’ll be able to produce a clearance form for the patient who has just undergone treatment. Also, you can mention what you’re most concerned about the patient’s health and also any restrictions that you feel should be addressed. Don’t wait for tomorrow. Download it now!

4. Standard Medical Clearance Request Form Template

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  • PDF

Size: 120.0 KB

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Are you looking for a document that will help you in preparing a medical clearance before carrying out a surgery? This template will let you request to use anesthesia for a patient who is over the age of 45 and requires a clearance before going for a surgery. This template will provide you with the basic ideas of how you can prepare your form. Avail it now to take it as an example for your next clearance request. You can take help from our form templates in Google Docs in case you’re comfortable with this format.

5. Medical Clearance Request Form Example

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  • PDF

Size: 223.3 KB

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Have a look at this medical clearance request form example template that will be a perfect example for you in preparing a form to request medical clearance. This template includes a request for the medical clearance of a person who is about to be employed in a child-care setting so that it is evident that the ones who are providing care are in good health and mental condition. Make one for yourself with the help of this printable medical authorization form instantly without any hassle.

6. Basic Medical Clearance Request Form Template

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  • PDF

Size: 261.2 KB

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Are you wondering how you will manage to create a medical clearance request form in less time? Well, we might have a solution to your problem. This request form template in PDF will be your solution as it carries out a basic medical clearance request that carries out the important questions like providing the personal information of the patient along with the phone number, hospital name, surgical coordinator and the ordering physician, etc. Download it now so that you can make your task much easier and finish it in less time.

7. Simple Medical Clearance Request Form in PDF

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  • PDF

Size: 220.4 KB

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It requires a lot of effort and time to produce a medical clearance request form. But not when you utilize this template for your reference purpose. This template contains a medical release form for a person who is opting to work in a foster facility that has to be reviewed and signed by the physician. It will declare that the person is healthy enough to work anywhere without any health issues or mental problems. Avail it now!

8. Formal Medical Clearance Request Form Example

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Size: 77.2 KB

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Do you seek to construct a medical clearance request form for someone who has respiratory problems? If so, then stop right here, as we might have a suitable template that matches your demands. Get your hands on this formal medical clearance request form template sample which can be an appropriate example for your purpose. It lays out the personal information of the employee, the organization in which he/she works, respirator types that have to be used, and the physician’s evaluation. Download this useful template now!

9. Simple Medical Clearance Request Form Template

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  • PDF

Size: 24.8 KB

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Get your hands on this beneficial template as it will provide you the fundamental information which is required in a medical form. Through this form, you can request medical clearance from the particular physician who provided the treatment or medication. This will help in making it easier for the patient to apply for any other program or further surgeries if necessary. Why miss this opportunity? Download now.

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