Physical Exams Form.docx

PHYSICAL EXAMS

Panel 1 - Baseline Exam(1st Year) and/or Pre-Hire Exam

State of Nevada Medical History Form **Job Specific Medical History Form (to be determined by vendor for pre-hire exams only) Audiometry with interpretation (identify air conduction or pure tone test) Blood Pressure Monitoring Chest X-Ray (1 View) – radiologist over read Coronary Risk II (CBC + Chem Panel + HDL + LDL) Heart and Lung Physical Exam Resting EKG ** Stress EKG (If 2 or more risk factors for heart disease identified or employee is 40 years of age or older) Pulmonary Function Test (Spirometry) TB Skin Test: 2 Step for Depart of Corrections, Lakes Crossing, SNAMHS, 1 Step for all other agencies.

Urinalysis Nicotine Test (Cotinine only) with Quant Levels Per-Cent Body Fat (BMI Method)/Waist Circumference Vision Screening State of Nevada Physician’s Report of Results Form Written Report to Agency and Employee **Note: Written report must document rationale in regard to whether or not a Stress EKG test was administered and document whether or not the employee worked for another police/fire or correctional jurisdiction) Hepatitis ABC Antibody Screening Hepatitis A/B Inoculation Series, (3 shot) must be offered if the employee has not been previously inoculated - Vendor must provide employee with a card identifying status and dates of inoculations Heplisav – B inoculations (2 shot)

* A1C – If employee has documented Diabetes

Panel 2 - Physical for Non-Sworn Training Officers – State Fire Marshal’s Office (Performed annually)

Panel 3 - General Heart/Lung Exam (Over 2 years of Service)

State of Nevada Medical History Form Heart and Lung Physical Exam Audiometry with interpretation (identify air conduction or pure tone test) Blood Pressure Monitoring Chest X-Ray (2 View)-radiologist over-read Coronary Risk II (CBC + Chem Panel + HDL + LDL) *A1C – If employee has documented Diabetes Per-Cent Body Fat (BMI Method)/Waist Circumference Stress EKG Pulmonary Function Test (Spirometry) TB Skin Test (Exception: Employees of Department of Corrections, Lakes Crossing do not receive.)

Urinalysis Nicotine Test (Cotinine only) with Quant Levels State of Nevada Physician’s Report of Results Form Vision Screening Written Report to Agency and Employee Hepatitis ABC Antibody Screening Hepatitis A/B Inoculation Series, or Heplisav -B inoculation if indicated- Vendor must provide employee with a card identifying status and dates of inoculations **CDL or HAZ MAT Exams ** (Optional Service) **Work Capacity Readiness Form-Division of Forestry only (form to be provided) ** Other tests to confirm or rule out Heart or Lung disease if indicated – Vendor to list additional tests and related cost.

Panel 4 - Division of Forestry Physical – Red Card (employees who are not firefighters)

Audiometry with interpretation (identify air conduction or pure tone test) Chest X-Ray (1 View) Pulmonary Function Test (Spirometry) Resting EKG

Panel 5 - Volunteer Firefighter Exam - (Baseline-Every Even-Numbered year)

State of Nevada Medical History Form Heart and Lung Physical Exam Audiometry with interpretation (identify air conduction or pure tone test) Blood Pressure Monitoring Resting EKG Chest X-Ray (1 View) radiologist over read Coronary Risk II (CBC + Chem Panel + HDL + LDL) Pulmonary Function Test (Spirometry) Per-Cent Body Fat (BMI Method)/Waist Circumference Urinalysis Nicotine Test (Cotinine only) with Quant Levels TB Skin Test Vision Screening State of Nevada Physician’s Report of Results Form Written Report to Agency and Employee (optional) Hepatitis A/B Inoculation Series (First year only, if indicated) Hepatitis ABC Screening *A1c if employee has documented Diabetes

**Some Exams may require a CDL Exam or a HAZMAT exam –the individual agencies are responsible to identify which exams need to have these additional exams performed.

Vendors must identify the cost of these additional services when performed in conjunction with these annual exams and list the cost for these exams if they are performed independent from these annual physical exams.

Revised 7-5-23