When bringing forms to the office for the doctor to fill out, please remember the following:
Blank forms will not be accepted. Forms will only be accepted for completion if the child’s name and other information has been completed. Parents must sign all forms in appropriate spots giving us permission to complete your child’s form. Print the forms you need and fill out the parent section before you submit forms to our office. To assist you, links to commonly needed forms are listed below.
Turnaround time for form completion may be up to 7 business days. Parents should realize that at certain times of the year we may receive many health forms in one week, and remember that each of these has to be carefully reviewed by a physician before it is released. Parents are strongly advised not to wait until the last moment.
Forms will be held here for parents to pick up. Because of Health Insurance Portability and Accountability Act (HIPAA) regulations, forms will be released to parents only. If you would like a form to be mailed to the home address on file, please provide us with a self-addressed stamped envelope.
Most forms require the information to be based on an examination completed within 12 months of the date the form is completed or may require specific evaluations that may not have been performed at the routine physical (for example, sports vitals after running, asthma/allergy treatment plans, etc.). An additional office visit may be required. If your child has not had a physical within the past 12 months, our staff will assist you in scheduling one.
While our office does not currently charge for many routine forms such as school physical, sports physical, or medication forms, there may be a fee for more lengthy or specialized forms such as FMLA, or if “rush service” is needed (forms that need to be completed within 24 hours). The office staff will notify you of any fees if applicable. Insurance companies do not reimburse for form completion and we do not bill insurance for completing any forms.
Physician’s Report - Day Care Centers (Child’s Pre-admission Health Evaluation) -- Health evaluation form required for admission to day care or preschool. http://www.cdss.ca.gov/cdssweb/entres/forms/English/LIC701.pdf
State of California Report of Health Examination for School Entry -- California public school form required for entrance into kindergarten/1st grade. http://www.dhcs.ca.gov/formsandpubs/forms/forms/childmedsvcforms/pm171a(bi).pdf
Sacramento City Unified School District Sports Physical form -- Sports physical forms are now linked to each school’s website. Please visit your child’s school website and follow the links to the Sports Physical Form.
Sacramento City Unified School District Medication Authorization form -- SCUSD form required for medication to be given at school. http://www.scusd.edu/document/medication-authorization-form
Elk Grove Unified School District Sports Physical form -- EGUSD form required for participation in school sports (scroll down to “Sports Physical Exam”). http://blogs.egusd.net/athletics/forms/
Elk Grove Unified School District Authorization of Medication for Pupils -- EGUSD form required for medication for be given at school (scroll down to “Authorization of Medication for Pupils”). http://www.egusd.net/students-families/egusd-forms/
Please note: If you are unable to view the forms, you may need to download Adobe Acrobat reader for free by clicking on the icon below.