Pare Medical Form PDF Details

At the heart of ensuring the safety and preparedness of individuals for physically demanding roles, the Pare Medical form presents a comprehensive evaluation tool. This critical document, meticulously designed for the assessment of physical fitness, delves into personal health details and scrutinizes potential medical constraints that could hinder the completion of the Physical Abilities Requirement Evaluation (PARE), a maximal physical exertion test. The form is segregated into distinct sections, each focusing on vital health considerations such as pulmonary and musculoskeletal restrictions, cardiovascular risk factors, and specifically for individuals above certain age thresholds, the risks of coronary artery disease. With a clear directive for a preliminary Exercise Stress Test under specific conditions, it emphasizes an evidence-based approach to assess fitness levels. Importantly, the PARE Medical form also reserves space for the physician’s professional recommendation based on a thorough review of the applicant's health status and the potential risks involved, ultimately determining whether an individual is medically fit to embark on the PARE test. This pivotal process not only underscores the significance of safeguarding participant health but also serves as a preventive measure against potential health crises during the strenuous activities demanded by the evaluation.

QuestionAnswer
Form NamePare Medical Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namespare medical clearance, pare form forms, pare form download, rcmp pare medical police

Form Preview Example

PARE Medical Clearance - Part 1

Protected B once completed

PIB CMP/P-PE-808

PIB CMP PPU 070

Det. / Unit - For Member Use Only

HRMIS / Applicant ID

Patient Information

Surname

 

Given Names

Gender

 

Age

 

 

 

Female

Male

 

 

 

 

 

 

Height (cm)

Weight (kg)

Resting Heart Rate

Resting Blood Pressure

 

 

 

 

 

 

Risk Factors

Note to Physician

The Physical Abilities Requirement Evaluation (PARE) is a maximal physical exertion test equivalent to an Exercise Stress Test at the 12 Metabolic Equivalent for Task (MET) level. The following are risk factors to consider when assessing suitability for PARE.

Section A - For All Individuals - Pulmonary And Musculoskeletal Restrictions

If yes to any one risk factors in Section A, patient should not undertake PARE.

Pulmonary obstruction / restriction that would prevent maximal testing.

Needs to use a short acting inhaler immediately prior to participate in maximal testing. (Short acting inhalers can only be used after the test if needed. Long acting or combined inhalers are allowed.)

Musculoskeletal restrictions that could interfere with strenuous activities or maximal testing.

Yes No

Yes No

Yes No

Section B - For All Individuals - High Or Very High Cardiovascular Risk Factors (ATP III 1 & CMAJ 2) If yes to one or more risk factors in Section B, it is recommended to send patient to an Exercise Stress Test before clearing for PARE.

Previous CVA, MI, vascular surgery or any clinical evidence of atherosclerosis

Yes

No

Diabetes 3

Yes

No

Metabolic Syndrome

Yes

No

 

 

 

 

Section C - For Men > Age 40 And Women > Age 50 - Coronary Artery Disease Risk Factors (ACSM 4 & CSEP 5)

 

If yes to two or more risk factors in Section C, it is recommended to send patient for an Exercise Stress Test before clearing for PARE.

 

 

Family history of premature cardiovascular disease

Yes

No

Cigarette smoking

Yes

No

Hypertension 6

Yes

No

Dyslipidemia

Yes

No

Abnormal fasting glucose level

Yes

No

Obesity 7

Yes

No

Physical inactivity

Yes

No

 

 

 

 

 

Section D - Exercise Stress Test (when Required)

 

 

Clinically positive for ischemia

Yes

No

Electrically positive for ischemia

Yes

No

Number of MET reached (12 MET are required prior to undertaking PARE)

 

 

 

 

 

 

 

Additional tests (if needed, specify):

 

 

Medical References

1)Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. (Adult Treatment Panel III). National Institute of Health. National Heart, Lung and Blood Institute.

2)Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: 2003 update. CMAJ appendix 2003; 168 (9) 921-924.

3)Report of the Expert committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2003; 26 (supp 1):S5-S20.

4)American College of Sports Medicine, Cited in ACSM Guidelines for Exercise Testing and Prescription, Seventh Edition. 2006.

5)Canadian Society of Exercise Physiology. Professional Fitness & Lifestyle Consultant. Resource Manual. 2004.

6)Canadian recommendations for the management of hypertension (2005)

7)Canadian Guidelines for Body Weight Classification in Adults (2003)

RCMP GRC 3986e (2013-12)

Part 1 - Page 1 of 1

PARE Medical Clearance - Part 2

Protected B once completed

PIB CMP/P-PE-808

PIB CMP PPU 070

Det. / Unit - For Member Use Only

HRMIS / Applicant ID

Patient Information

Surname

 

Given Names

Gender

 

Age

 

 

 

Female

Male

 

 

 

 

 

 

Height (cm)

Weight (kg)

Resting Heart Rate

Resting Blood Pressure

 

 

 

 

 

 

Physician's Recommendations

After reviewing Part 1 of the PARE Medical Clearance and evaluating the following risk factors:

Pulmonary Obstruction / Restriction

Musculoskeletal Restrictions

High or Very High Cardiovascular Risk Factors

Coronary Artery Disease Risk Factors

Exercise Stress Test to 12 MET, if applicable

 

It is my professional opinion that the above named patient is:

medically fit to undertake the Physical Abilities Requirement Evaluation. not medically fit to undertake the Physical Abilities Requirement Evaluation.

Comments

Physician's signature

Date (yyyy-mm-dd)

Physician's stamp

RCMP GRC 3986e (2013-12)

Part 2 - Page 1 of 1

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2. Right after filling out the previous part, head on to the next step and fill out the essential particulars in these blanks - Section B For All Individuals, Previous CVA MI vascular surgery, Diabetes, Metabolic Syndrome, Yes, Yes, Yes, Section C For Men Age And Women, Family history of premature, Cigarette smoking, Hypertension, Dyslipidemia, Abnormal fasting glucose level, Obesity, and Physical inactivity.

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Regarding Canadian recommendations for the and Part Page of, make certain you do everything properly in this current part. Those two are thought to be the most significant fields in the form.

4. The next part will require your input in the subsequent areas: PARE Medical Clearance Part, Det Unit For Member Use Only, HRMIS Applicant ID, Patient Information, Surname, Given Names, Gender, Age, Height cm, Weight kg, Resting Heart Rate, Female, Male, Resting Blood Pressure, and Physicians Recommendations After. Ensure that you fill in all of the required details to go forward.

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5. The document has to be wrapped up with this particular section. Below there can be found a full listing of blank fields that must be completed with accurate details for your document usage to be complete: Physicians signature, Date yyyymmdd, Physicians stamp, RCMP GRC e, and Part Page of.

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