Heart and Lung Physical Examination Form.docx

DOCX document 17 KB Posted

Attached to
Occupational Health Services
Solicitation number
99SWC-S2474
Issued by
Churchill County, Nevada

About this file

The document is a Heart and Lung Physical Examination Form for the State of Nevada. It outlines the required medical examination for individuals seeking occupational health services contracts with the state. The form captures detailed physical examination data including height, weight, BMI, visual acuity, and vital signs. It also includes assessment of the eyes, ears, neck, heart, lungs, and extremities, noting any abnormal findings. This medical examination is a prerequisite for the Occupational Health Services contract opportunity in the State of Nevada.

The Occupational Health Services contract opportunity is for the state government. The contract will likely involve providing occupational health services and examinations to state employees. No other specifics regarding the scope, quantities, response dates, or contract term are provided in the given materials.

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Text version

State of Nevada Heart and Lung Physical Examination

NAME_____________________ AGENCY__________________ DATE_____________

Height (in)_________ Weight (lbs)________ BMI______ Waist Circumference ________

Sex: Male ____ Female ____

Temp________ Pulse________ Resp___ (BP Sitting)________

Visual Acuity: O.D._______ O.S.________ O.U.__________Corrected? Yes No

RESULT
DESCRIPTION
EYES
Fundi
NL
ABN
EARS
TM’s
NL
ABN
NECK
Thyroid
NL
ABN
Carotids
NL
ABN
Bruits
NL
ABN
HEART
Rhythm
Reg
Irreg
Murmurs
Yes
No
S3 or S4
Yes
No
LUNGS
Rales
Yes
No
Ronchi
Yes
No
Wheezes
Yes
No
EXTREMITIES
Pulses
NL
ABN
Clubbing
Yes
No
Edema
Yes
No
Cyanosis
Yes
No

Revised 6-23

File details come from the government source that posted it. Updated .