Preparation For Your Paramedical Exam

With both quality assurance and specimen integrity in mind, a checklist was devised to aid in the preparation for your paramedical exam. Following this checklist will serve to considerably shorten your paramedical exam and offer you the best opportunity in achieving the most positive results thus improving your insurability and chance for the lowest possible insurance premium. Most of our clients elect to print and use this as their check-off, hard copy. (Note: Highlighting only the list prevents printing the entire web page). We thank you in advance for your effort in completing our 1 1/2 page checklist and providing this to your examiner. With the completion of this checklist, your exam should take approximately 20 min. unless an EKG has also been ordered. Actual exam time is predicated largely on the extent and scope of your health history. Having taken the time to fill this out, you may wish to make a copy of this updated record of your health history for your files as well. Be confident your examiner will not only be very skilled, amicable, and professional, but also very appreciative upon your presentation of this completed checklist. REQUIREMENTS and RECOMMENDATIONS CHECKLIST (To print, highlight by left-clicking just left of list below and drag to bottom of form. Then, while in shaded area, right click and select "print", and finally left click both "selection" and "OK"). ___ Because stress can affect blood pressure, try to schedule your exam for the least stressful time of the day. ___ Wear short sleeved or loose fitting clothing to allow access to your upper arm for obtaining blood pressures. ___ Please refrain from smoking or consuming alcohol at least 1 hr. and 8 hrs. respectively, prior to your exam. ___ We ask the you provide some photo identification (drivers license, military, or state ID). ___ A urine sample will be required, unless notified otherwise. Lab results are often improved by consuming plenty of water during the hours prior to a blood/urine collection. Minimally, we ask that you consume one glass of water 30 min. prior to your exam to aid in providing a urine sample. The examiner will provide a container during the exam. Due to sample degradation, etc., urine collected prior cannot be accepted. ___ A minimum of a 5-6 hour fast is required to accurately run specific chemistries on your blood sample. Your examiner will distinguish whether your insurance company requires venous blood (most common) or a "finger stick". (A fast is not required for the finger stick). Fasting involves having nothing but water (or coffee or tea without cream or sugar) during the 5-6 hour period prior to your exam. Remember to drink plenty of water as this tends to improve lab results, and a complete fast (without water) would certainly be counterproductive to both your health and lab results. Diabetics and expectant mothers may reduce their fast to 3-4 hours on an individual basis if minimal dietary suggestions are followed. Please inform us of your individual condition when scheduling if applicable. ___ As a precaution, please alert your examiner if you tend to become nauseated or have fainted during previous blood draws. We can lie you down during your draw and will be as patient or as quick with the procedure as you allow. However to decrease your chance of fainting, we ask that you make an attempt not to become overly concerned about your blood draw. Please trust that we are trained professionals who draw clients with concerns everyday. We take pride in providing virtually painless "sticks" and enjoy hearing the same from our clients. ___ A copy of your lab results can normally be obtained by signing a letter of authorization for the insurance Co. to release your results to you. The results are normally mailed to you, and/or an additional party you designate (i.e. your personal physician), within ~2 weeks. If your agent cannot provide a form of this nature, you can simply write and sign a brief note to this effect. Due to client confidentially, neither your examiner, nor your agent, become privy to your laboratory results. ___ Please provide the complete names, addresses and phone numbers of your primary care provider, OB/GYN, or specialist/s, if applicable. When noting the date/s of consultation, the general year is fine. However, if it was a recent consult, try to provide a month as well. This includes all physical exams, major & minor surgeries, visits to emergency rooms, Urgent Care facilities, physical therapists, chiropractors and dentists (only if extensive oral surgery was performed). This is applicable for the last 10 years only, but include any current conditions you may still have. Please accompany dates with the diagnosis (DX), treatment (TX), outcome and attending physician (to the best of your recollection). 1.Date,DX,TX,outcome:______________________________________________________________________ Physician:________________________________________________________________________________ 2.Date,DX,TX,outcome:______________________________________________________________________ Physician:________________________________________________________________________________ 3.Date,DX,TX,outcome:______________________________________________________________________ Physician:________________________________________________________________________________ 4.Date,DX,TX,outcome:______________________________________________________________________ Physician:________________________________________________________________________________ 5.Date,DX,TX,outcome:______________________________________________________________________ Physician:________________________________________________________________________________ 6.Date,DX,TX,outcome:______________________________________________________________________ Physician:________________________________________________________________________________ ___ Please list RX's and dosage with approximate, original date prescribed for all medication you've taken within the last 5 years, regardless of whether you are still taking them or not. Also list RX's you may no longer take for any reason but still have a current RX. for. Please be assured we will annotate each RX accordingly to explain why you may or may no longer be taking them. Please remember to include antibiotics, birth control, over the counter (OTC) meds. and vitamins and/or herbal supplements, if applicable. RX:_________________________Dosage____________________Date prescribed____________________ RX:_________________________Dosage____________________Date prescribed____________________ RX:_________________________Dosage____________________Date prescribed____________________ RX:_________________________Dosage____________________Date prescribed____________________ RX:_________________________Dosage____________________Date prescribed____________________ RX:_________________________Dosage____________________Date prescribed____________________ RX:_________________________Dosage____________________Date prescribed____________________ RX:_________________________Dosage____________________Date prescribed____________________ RX:_________________________Dosage____________________Date prescribed____________________ RX:_________________________Dosage____________________Date prescribed____________________ Over the Counter (OTC) MEDS:_______________________________________________________ VITAMINS:___________________________________ VITAMINS:___________________________________ VITAMINS:___________________________________ VITAMINS:___________________________________ HERBAL or MINERAL SUPPLEMENTS:________________________________________________