Lincoln's Challenge Physical Exam Worksheet Summary

This document is a medical intake and clearance form for the Lincoln's Challenge Training Program. It serves as an entrance examination worksheet designed to assess participant eligibility and document medical findings, immunization status, and health history. The form does not identify a specific state, agency, or contracting entity, but rather functions as an internal medical screening tool for the program's enrollment process.

The form captures comprehensive health information including physical measurements (height, weight, blood pressure, pulse, temperature, and vision), a detailed physical examination covering 24 body systems with normal/abnormal notation fields, and a complete health history screening for conditions such as allergies, asthma, diabetes, heart problems, and prior surgeries or hospitalizations. The immunization section documents administration of OPV, DT, MMR, measles-only vaccine, and TB skin testing, with fields for lot numbers, expiration dates, administration sites, and provider initials. The worksheet concludes with signature lines for the examining physician and nursing/technical staff. The form determines whether participants are qualified to complete the training program and whether they mentally understand the program's purpose and requirements.