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Get and Sign Legacy Medical Group Business Health Services 2018-2022 Form
Immunizations Hepatitis A Appt. Clean ears prior to appt. to avoid delayed service Titmus visual acuity Physicals Please wear work attire to fit job duties performed DOT - Dept. Only Vaccine Immunity Titer Hepatitis B Vaccine please list any known injection history below Date 1 Yes I received injections see dates above No I have never received Hepatitis B injections TB Tuberculosis Screening Step 1 Step 2 within 1 year of Step 1 TB X-ray 1 View Chest X-Ray with Nurse Consult recommended 2 View...
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