Medical examination for employment Form

Medical examination for employment Form: What You Should Know

Department of Consumer Affairs, Division of Workers' Compensation Employees—submits medical certificate and/or completes health examinations in accordance with District procedures and current law. For more information see the PDF form (PDF). (Division of Workers' Compensation, Department of Consumer Affairs, 100 East Washington Avenue, Suite 300, Sacramento, CA 95814 Tel: Fax: Email:) 2. CCD Department of Consumer Affairs, Division of Workers' Compensation Employees—submits medical certificate and/or completes health examinations in accordance with District procedures and current law. For more information see the PDF form (PDF). (Division of Workers' Compensation, Department of Consumer Affairs, 100 East Washington Avenue, Suite 300, Sacramento, CA 95814 Tel: Fax: Email:) Medical Examination and History Report As requested on the Medical Certificate, completed all the requested portions of a medical exam in an examination conducted in accordance with California Department of Industrial Relations (DHR) requirements as follows: (1) Health Examination — DHR Form 7001 (PDF), and a Medical Exam, DHR Form 7001 (PDF), or other form with equivalent language, in accordance with DHR requirements as follows: A. Complete a Medical Examination and Health History Report, (DHR Form 7001), which includes: (2) The date of the examination; (3) A medical history, including a mental health history, any chronic condition and any other significant medical conditions; A. Physical Ability Test (PAT): DHR Form 6520 A (PDF), or a State-approved alternative form; and B.

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