Sssa Student Medical Check List Template - Mustang Medical Of North Carolina, P.a. printable pdf download

Sssa Student Medical Check List Template - Mustang Medical Of North Carolina, P.a.

SSSA Student Medical Check List

*** Physical, labs, immunizations and hearing can be done at Mustang***

Physical

Medical Forms DD FORM 2807-1 and DD 2808(fully completed within 90 days). Please review disqualifying criteria…BMI >35 or

weight > not to exceed 300lbs, BP 140/90 and greater, etc. Your BMI and blood pressure will be checked here.

*Mustang may request recent labs less than 90 days old due to chronic disease or illness.

Labs

G6PD (done at Ft. Bliss at no cost)

HbA1C (if glucose <110)

ABO / Blood Type-official documentation (medical forms, Red Cross card)

CMP (within 90 days)

Lipids (35 years or older within 90 days)

PSA (50+ within 90 days)

HIV from Serum (within 120 days)

Varicella Titer (food for a lifetime)

CBC (Complete Blood Count) (within 90 days)

Pregnancy Test (within 30 days)

Immunizations Please bring any Adult Immunization (Shot) Records. If you are enlisted or prior service member bring

any medical records (to include your immunizations) when you come to medical. Shots are a requirement for CRC

however, some Immunizations are valid for life and will not be required again if we have the proper documentation.

Hepatitis A – 2 shot series, good for a lifetime

Flu Shot – Current

Hepatitis B – 3 shot series, good for a lifetime

Zoster (one shot after age 60 regardless of history)

Typhoid – Injection/Oral – good for 2 years/5 years

Pneumococcal (65 years and older)

PPD Test and Reading – within 90 days (if positive then documented treatment, chest x-ray, or waiver required)

MMR –two adult dose, good for a lifetime (not required if born before 1957)

Polio – Location specific annually, otherwise one as an adult.

Varicella “Chicken Pox” (2 shot series if born after 12-31-1979 or proof of titer)

Tdap – good for 10 years

Hearing

DD2215 form

***Dental and Vision are good for a year and can be done off site in the time allotted ***

Dental

Dental DD Form 2813 (2017 edition) completed and signed by a dentist. To deploy, a student must be designated as class 1 or 2.

Evidence of panoramic x-ray (within 5 years or box 5 checked on DD2813)

Vision

Only required if you wear glasses. Contacts not permitted and must have 2 pairs of glasses.

Sssa Student Medical Check List Template - Mustang Medical Of North Carolina, P.a.