Pare Medical Form – Fill Out and Use This PDF

Pare Medical Form is an online health and medical form provider. We offer a convenient and secure way to gather patient information, securely store it all in one place, and handle submissions. Our team has ties to the clinical management and legal arenas, ensuring our services are top quality when it comes to accuracy and reliability. Our medical forms simplify the data management burden and can be quickly customized to accurately record key medical information. Plus, our products also have swift turn around times for processing.

Pare Medical Form PDF Details

As a medical provider, ensuring the safety and security of your patient's information is crucial. The Privacy Rule established by the US Department of Health & Human Services requires that all healthcare organizations develop policies and practices to both protect their patients' sensitive information and ensure its effective use. One such policy is the Patient Authorization Form (often referred to as Pare Medical Form). This form allows patients to grant permission for specific uses or disclosures of their health information. To help you better understand the role this important document plays in protecting your patient's privacy rights, we’re going to dive into what it is, why it's needed, when it should be used, and how best to implement it in your practice.

Question	Answer
Form Name	Pare Medical Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	pare 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

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

How to Edit Pare Medical Form Online for Free

You can fill in pare medical clearance form without difficulty by using our online tool for PDF editing. Our tool is continually developing to give the very best user experience achievable, and that's thanks to our commitment to constant development and listening closely to customer feedback. By taking a few basic steps, you can begin your PDF journey:

Step 1: Simply click the "Get Form Button" at the top of this webpage to start up our pdf form editing tool. There you will find all that is required to work with your document.

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It is straightforward to complete the pdf with our detailed tutorial! Here's what you have to do:

1. It is important to complete the pare medical clearance form properly, so pay close attention while working with the parts comprising these specific fields:

canada pare medical police completion process shown (stage 1)

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.

canada pare medical police conclusion process clarified (part 2)

3. Completing Canadian Society of Exercise, Canadian recommendations for the, Canadian Guidelines for Body, RCMP GRC e, and Part Page of is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Simple tips to fill in canada pare medical police part 3

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.

How one can complete canada pare medical police part 4

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.

canada pare medical police completion process clarified (stage 5)

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Pare Medical Form – Fill Out and Use This PDF

Pare Medical Form PDF Details

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