Foster Care Manual: Staff Physical
You are the Staff and are required to have a physical every 2 years. It includes a TB test. Your regular doctor is authorized to give the physical exam.Staff Physical
Name:_______________________________ Age:______________
State regulations require that the physical examination include:
1. A general physical examination.
3. Information on any medical problems which might interfere with the health of the residents.
I certify that the above named individual is in good health and able to care for clients placed in his/her home. Clients may have physical and or mental handicaps. I certify that he/she is free of communicable diseases, has had tuberculosis screening, and has no medical problems which might interfere with the health of clients.
Comments (if any) _____________________________
_____________________________________________
_____________________________________________
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Physician / Nurse Practioner /Date:________________
Physician’s Assistant:____________________________
Please print name: ______________________________
Address:_______________________________________
Telephone number:______________________________
California
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