Sample Medical Screening Form

This Sample Medical Screening Form is an example of the medical screening form that will be used to determine which medication an individual may receive. This sample is for training purposes only and is not the actual form that will be used in a POD. In the event of a public health emergency the Health District will provide the appropriate medical screening form.
Click the link below to download the Sample Medical Screening Form:

Last modified on 04/03/2017