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Patient Medical Clearance Form

Patient Medical Clearance Form

CSTAR Patient Medical Clearance Form

  • This form is intended to provide CONFIDENTIAL information to assure CSTAR International that the patient is fit to travel. If the patient is acceptable for air travel, this information will permit the issuance of the necessary directives designed to provide for the patient’s welfare and comfort. A MEDICAL PROFESSIONAL (Doctor or Nurse) of the patient is requested to ANSWER ALL QUESTIONS in ENGLISH or SPANISH.
  • Vital Signs/Signos Vitales

  • Please take pictures of Patient's Incision, burns, etc. / Tome fotografías de la incisión del paciente, quemaduras, etc.

 

Verification