Co request for new medicals

Here is a sample request for new medicals:

Request for New Medical Examination

Employee Information:

• Name: [Insert employee name]
• Employee ID: [Insert employee ID]
• Job Title: [Insert job title]
• Department: [Insert department]

Reason for Request:

• [Insert reason for request, e.g. "annual medical examination", "new job requirements", "change in job duties", etc.]

Medical Information:

• Date of Birth: [Insert date of birth]
• Height: [Insert height]
• Weight: [Insert weight]
• Blood Pressure: [Insert blood pressure]
• Any pre-existing medical conditions: [Insert any pre-existing medical conditions]

Medical History:

• Please provide a detailed medical history, including any previous illnesses, injuries, or surgeries.

Medications:

• Please list any medications you are currently taking, including dosages and frequencies.

Allergies:

• Please list any allergies you have, including any medications or substances.

Special Requests:

• Are there any special requests or accommodations you require for the medical examination? (e.g. wheelchair accessibility, interpreter services, etc.)

Authorization:

• I hereby authorize [Insert name of medical provider] to conduct a medical examination and provide a medical report to [Insert name of employer].

Signature:

• I hereby certify that the information provided is accurate and complete to the best of my knowledge.

Date:

• [Insert date]

Employee Signature:

• [Insert employee signature]

Medical Provider Signature:

• [Insert medical provider signature]

Please note that this is just a sample request and may need to be modified to fit your specific needs and requirements. It's also important to ensure that the request is compliant with any relevant laws and regulations.