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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Other files
| File | Type | Posted |
|---|---|---|
| Physical Exams Form.docx | DOCX document | |
| Quote Instructions.pdf | ||
| Reference Questionnaire 2023-04-13~1.docx | DOCX document | |
| Standard Form Contract~5.docx | DOCX document | |
| 99SWC-S2474 Cost Schedule.docx | DOCX document | |
| 99SWC-S2474 Q and A Answered..xls | XLS spreadsheet | |
| 99SWC-S2474 Technical Requirements Questionnaire.docx | DOCX document | |
| Attachments for Signatures 2023-04-13~1.pdf | ||
| 99SWC-S2474 Letter of Intent.pdf | ||
| 99SWC-S2474 RFQ Occupational Health Services~1.docx | DOCX document | |
| Projected Physicals for Years 2024-2028.docx | DOCX document | |
| Proposed Staff Resume 2023-04-13~1.docx | DOCX document | |
| 99SWC-S2474 Insurance Schedule.docx | DOCX document | |
| Firemen and Police Medical History Form.doc | DOC document | |
| Risk Factor Levels for Various Conditions.docx | DOCX document | |
| Terms and Conditions for Services 2023-04-13~1.pdf |
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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 .