Medical Clearance Form Template

Benefits of this Medical Clearance Form Template

Multiple Sharing Options

Our platform allows you to share clearance forms through multiple channels. This helps your hospital staff to reach out to the patient in their preferred channel. You can share the form through SMS, WhatsApp, QR Code, direct form link, webpage embed, and emails.

Collect Documents

With the file upload feature collect clearance documents like immunization records, lab tests, and medication lists from your patients. They can simply drag and drop their files onto the form to upload, and you can access them in the dashboard.

Get Email Notifications

Get notified with responses every time the clearance form is filled. You can also set up a thank you email for the patient once they complete the form. You can customize the email content, make it personalized, and stay on track with medical clearances.

Set Up Reminders

Instead of constantly sending manual reminders to your patient, set up automated reminders in our platform. Once configured the platform will send email reminders to patients to declare their medical clearance. Sending automated reminders at regular intervals ensures there is no delay in medical procedures.

Get a Printable Version Instantly

Once you customize the form for your needs, you can instantly download the printable version of the clearance form. PDF forms help you during one-to-one interaction with the patients. You can download it in portrait or landscape format.

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Where can this Medical Clearance Form Template be useful?

Medical clearance is the initial check conducted by doctors to ensure that a patient is physically fit to undergo a surgery, treatment, or work in a tough environment. It includes a complete head-to-toe physical assessment by the doctors. Usually, it is conducted before a surgery, but medical clearance is also done for the following cases,

To check athletes’s fitness levels before a sports event

Athletes go through a rigorous physical assessment by doctors before participating in a sports event. They need to satisfy the physical fitness requirements to be eligible for competitions. This template can be customized accordingly and can be used to document clearance procedures.

To conduct occupational health checks for on-site workers

Certain on-site jobs like working in petroleum plants, nuclear plants, construction sites, mining sites, military, etc demand workers to be at their peak health conditions. It’s a common practice for them to go through a medical clearance procedure to ensure that they meet the necessary fitness levels. This template can be customized based on the conditions considered for medical fitness.

Try our Construction Incident Report Form Template

To conduct medical checks before adventure activities

Before carrying out any adventure activities like trekking, paragliding, or deep-sea diving, it is necessary to ensure that participants are physically fit. You can customize this template and share medical clearance forms to collect the necessary details. The forms also help you to keep a documentation of all health records of your clients, which is better for future reference.

How SurveySparrow ensure data security with HIPAA Compliance

SurveySparrow follows all guidelines falling under HIPAA compliance making it a perfect tool for data management in healthcare institutions. You can use our platform for collect feedback at different touchpoints, and collect information from patients, visitors, doctors, and nurses.

Here are the features of SurveySparrow that ensure HIPAA compliance,

• Role-based access control - Multi-layered access control for owner, admin, and contributors. The admin has complete control of the account and the users, with features such as roles & access.
• Encryption - All data is encrypted in transit, end to end, and at rest using industry-standard Advanced Encryption Standard (AES) encryption using 256-bit keys to protect data encryption.
• Two-factor authentication - With the 2-factor authentication, users require the security code to log in to the SurveySparrow account. Even if someone finds your password, they cannot log in without your security code.
• Person or Entity Authentication - SurveySparrow has a policy that describes the process of verifying a person’s identity before unlocking their account, resetting their password, and/or providing access to ePHI.

Want to know patient feedback? Check out this Hospital Feedback Form Template