Medical conditions that preclude entry
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- Everett Allison
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1 Medical conditions that preclude entry If you have or have had any of the conditions listed below, it means that you do not meet the current medical standard required to enter Military Service: NB: This list is NOT exhaustive and other exclusion criteria may be identified at a medical examination Dental Current orthodontic treatment including fixed or removable braces Eye disorders Eye disease, for example glaucoma, keratoconus, retinitis pigmentosa Double vision (including ophthalmic migraine) Visual field defects or blind spots Corneal grafts or recurrent corneal ulcers Cataract or cataract surgery Detached retina Vision only in one eye Squint surgery in the previous six months Laser eye surgery in the previous 12 months, if more than 12 months has elapsed you must be a minimum of 22 years of age at time of application Any eye disorder which causes a disability (including eye injury which reduces function). Ear, nose and throat disorders Current ear, nose, throat or sinus disease Significant impairment of hearing Presence of grommets Current perforated eardrum Recurrent nose bleeds (more than one per week) Persistent facial nerve palsy Meniere s disease Nasal deformity-sufficient to interfere with the use of face masks, breathing apparatus and other similar devices Chronic rhinosinusitis (excluding seasonal hayfever) Nasal polyps Heart and cardiovascular disorders
2 Established heart disease Certain congenital heart conditions such as repair of tetralogy of Fallot, coarctation of the aorta Certain heart valve abnormalities High blood pressure (treated or untreated) Reynaud s disease Cardiomyopathy Hyperlipidaemia (treated or untreated) Familial Hyperlipidaemia/hypercholesterolaeimia Respiratory disorders Lung disease including: Chronic bronchitis Emphysema Bronchiectasis Cystic fibrosis Active tuberculosis Spontaneous pneumothorax which has not had definitive surgical treatment If you suffer from asthma or have done in the past, you cannot be considered for flying branches in the RAF. For ground branches and trades, individuals with a past history of asthma, wheezing or inhaler use may be eligible for service following review of the past medical history by medical staff. If you currently have asthma symptoms or a current prescription or you use an inhaler for asthma or wheeze (regardless of cause), you are not eligible to apply for the Royal Air Force. Abdominal and digestive disorders, including diet Current symptoms of abdominal, digestive or liver disease Any history of Crohn s disease Any history of Ulcerative colitis Irritable bowel syndrome requiring medication or medical follow up within the last 2 years Loss of spleen for any reason (splenectomy) Chronic hepatitis of any cause Any untreated hernia Active pilonidal sinus or two surgical procedures as treatment Active haemorrhoids with a history of bleeding in the last 8 weeks Surgery for a peptic ulcer Surgery for a hiatus hernia Surgery to resolve reflux symptoms within the past twelve months Current or past history of chronic or recurrent oesophagitis Urogenital disorders Urinary incontinence in the preceding 2 years Genital infections if requiring frequent medical intervention Kidney transplant Confirmed history of kidney, bladder or ureteric stones
3 Non-specific groin/pelvic pain, recurrent testicular pain or undiagnosed loin pain Current kidney disease Polycystic kidney disease. Donation of a kidney in the past six months. Nervous System disorders Single seizure (fit) within the last ten years Petit mal with onset after the age of 10 or who have not been seizure free without treatment for 5 years Epilepsy of other causes with more than one seizure after the age of six Benign Rolandic epilepsy if not symptom and treatment free for 5 years Multiple sclerosis Head injury where there is any evidence of prolonged or persistent neurological, psychiatric or intellectual symptoms Hydrocephalus (with or without shunt) Severe or recurrent headache within the last 2 years Migraine or the use of preventative medication within the last 2 years Recurrent faints Peripheral nerve palsy or limb weakness Endocrine disorders Diabetes mellitus and diabetes insipidus Adrenal gland disorders Pituitary gland disorders Certain thyroid diseases Skin disorders Active eczema or dermatitis A history of severe eczema Active psoriasis which affects more than 5% of the body surface Severe acne with or without treatment Photosensitivity not controlled by sunscreens Severe excessive sweating with or without medical treatment Female reproductive disorders Prolonged history of breast pain (chronic) Prolonged history of pelvic pain or inflammatory disease (chronic) Endometriosis Abnormal cervical smear result within the last 12 months Pregnancy and breast feeding Current Pregnancy or child birth within the last 3 months Breast feeding should have ceased before entering military service
4 Male reproductive disorders Prolonged history of scrotal pain (chronic) Current or unsuccessful treatment for urethral abnormalities Current prostatitis or pelvic pain Musculoskeletal disorders Most spinal abnormalities Most spinal operations Most spinal fractures A single episode of back pain lasting longer than 12 weeks or 3 separate episodes regardless of duration and/or cause Joint disease causing pain or limitation of joint movement Hypermobility (laxity) of the joints Bone or joint operations within the last 12 months Replacement of any large joint Anterior or posterior cruciate ligament reconstruction 3 or more dislocations (including subluxation) of the same shoulder More than one shoulder stabilisation operation Congenital dislocation of the Hip Severe deformity following fractures Loss of a limb Foot abnormalities (e.g. club foot, bunions or hammer toe) Complete loss of either big toe Complete loss of either thumb Chronic arthritis of any cause and similar conditions Fractures within the last 12 months, except fractures of the digits / clavicles Any abnormality that interferes with the ability to undertake military training Blood disorders Sickle cell disease Congenital spherocytosis Haemoglobinopathy (except trait). Any history or current bleeding disorder or abnormality of blood clotting. Infections Human immunodeficiency virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) Carriers of hepatitis viruses Malignancy (cancer) Current and previous diagnosis of cancers, or Leukaemia within the last 5 years Conditions resulting from exposure to extremes of temperature Heat illness requiring medical intervention e.g. hospital admission Frostbite or non-freezing cold injury
5 Psychiatric disorders Current psychiatric illness Depressive disorders with or without treatment of any form in the last 3 years or 2 or more episodes in the last 4 years, or 3 episodes at any time. Anxiety symptoms within the last 12 months Psychosis Schizophrenia Obsessive-compulsive disorder Autism. Low level, high functioning Aspergers will be assessed on a case by case basis Attention Deficit Hyperactivity Disorder (ADHD) unless symptoms and treatment free for at least three years prior to application Personality disorder More than one episode of deliberate self-harm Post-traumatic stress disorder (PTSD) History of alcohol dependence Drug or substance dependence Anorexia and bulimia Gender Dysphoria if untreated or treatment incomplete. Treated gender dysphoria may be acceptable depending upon the current medical and surgical treatment stage and will be assessed on a case by case basis. Other conditions and diseases All congenital, chromosomal and genetic disorders Severe allergic reactions and/or anaphylaxis A need to carry adrenaline injections (EPIPEN, etc) Confirmed food allergy Any history of a Type 1 allergic reaction regardless of cause Latex allergy Specific vaccine allergy (including tetanus allergy) Gluten sensitivity (Coeliac disease), Any confirmed food intolerance which results in symptoms Chronic fatigue syndrome or associated disorders This list is provided for guidance only. If you have a medical condition that is not included, you are invited to contact your local Armed Forces Careers Office staff. Please note, AFCO staffs are not medically qualified, but your enquiry will be passed to the RAF Recruiting and Selection, Department of Occupational Medicine specialist medical team for guidance on your eligibility/suitability for entry. You should be aware that as part of the recruiting and selection process, all applicants will undergo a full pre-employment medical by one of our contracted Medical Examiners. This assessment is to confirm your medical fitness for military employment in your selected Branch/Trade.
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Healthcare History djp Pure-Health wellness centre www.pure-health.com Wellness Profile General Health On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the
Welcome to Medina Family Chiropractic and Acupuncture!
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Nutrition Consultation Intake Form Please write or print clearly
Artemis in the City, LLC Danielle Heard, MS, MS, HHC Clinical & Functional Nutritionist ph: 866-330-5421 fx: 212-535-3234 www.artemisinthecity.com Nutrition Consultation Intake Form Please write or print
DOB: / / Please list the names and telephone numbers of the other physicians involved in your care: Name Specialty Phone Address Receive Report (Y/N)
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City State Zip Code. Ethnic Background: Caucasian African-American Asian Hispanic Native American. Previous. Hobbies/Leisure activities:,,,
History # UPIN # (Please leave blank) Name: First M.I. Last Address: Street (Apt #) City State Zip Code Phone number: ( ) ( ) Home Business Birth Date: / / Day-Month-Year Gender: M F Marital status: (Maiden
Referral routes into Secondary Care by Specialty and Clinic November 2017
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MEDICAL HISTORY. Previous Nephrologist. Medication taken Insulin Oral Both. Who manages your diabetes? Blindness Yes No Hearing Problems Yes No
MEDICAL HISTORY Please mark YES or NO and fill in appropriate blanks as needed Chronic Yes No If yes, year diagnosed Previous Nephrologist Transplant Yes No If yes, date Donor type Living Deceased Related
Name: Age: DOB: / / City Zip Wk Tel: ( ) Cell: ( ) Referring Physician: How did you hear about Dr. Ordon?
Andrew P. Ordon, M.D., F.A.C.S. 465 N. Roxbury Drive, Suite 1001, Beverly Hills, CA 90210 Tel: (310) 248-6250 w Fax: (310) 861-1529 www.drordon.com Date: Name: Age: DOB: / / Address: Home Tel: ( ) City
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PATIENT MEDICAL HISTORY INTAKE FORM
Northgate Professional Center 1985 Main Street, Suite 209 Springfield, Massachusetts 01103 Tel; 413-455-1081 Fax; 413-391-7489 www.marimedconsults.com PATIENT MEDICAL HISTORY INTAKE FORM Patient Information: