PHYSICAL EXAMINATION FORM

This is to certify that ___________________________ had a physical examination on __________________,
                            Student’s Printed Name                                               Date

and is in good health, free of infectious disease, has no condition that would endanger the health and well-being
of other students or patients, and is able to undertake the technical standards (see attached sheet) of the
Physician Assistant Program at Bethel College.


               Practitioner’s Signature _________________________________________

               Date ________________________________________________________

               Practitioner’s Printed Name ______________________________________

               Address ______________________________________________________


               Office Phone Number ___________________________________________

                                      RETURN COMPLETED FORM TO:

                                      Bethel University PA Program
                                      ATTN: Admissions Director
                                      325 Cherry Avenue, Box 329
                                      McKenzie, TN 38201

DO NOT WRITE BELOW THIS LINE____________________________________________________

I have reviewed this document and acknowledge it as proof of a physical exam.

Clinical Director Signature: __________________________________________Date: _______________
                                           Technical Standards
A candidate for the Physician Assistant Program at Bethel College must have abilities and skills in five
categories: observation, communication, sensory/motor, intellectual, and behavioral/social. Reasonable
accommodation for persons with documented disabilities will be considered on an individual basis, but a
candidate must be able to perform in an independent manner. The use of a trained intermediary is not
acceptable in many clinical situations, in that it implies that a candidate’s judgment must be mediated by
someone else’s power of selection and observation. The following skills are required with or without

Observation: Candidates must have sufficient sensory capacity to observe in the lecture hall, the laboratory,
the outpatient setting, and the patient’s bedside. Sensory skills adequate to perform physical examination are
required. Functional vision, hearing, and tactile sensation must be adequate to observe a patient’s condition and
to elicit information through procedures regularly required in a physical exam, such as inspection, auscultation
and palpation. A candidate must be able to: observe a patient accurately, at a distance, and close at hand, with
or without standard medical instrumentation; acquire information from written documents, and visualize
information as presented in images from computer screens, paper, film, slides, or video. This includes, but is
not limited to, information conveyed through physiologic and pharmacological demonstrations in animals,
microbiological cultures and microscopic images of microorganisms and tissues in normal and pathologic
states. In any case where a candidate’s ability to observe or acquire information through these sensory
modalities is
compromised, the candidate must demonstrate alternate means and/or abilities to acquire and demonstrate the
essential information conveyed in this fashion. If the alternatives are
acceptable, it is expected that obtaining and using such alternate means and/or abilities shall be the
responsibility of the student.

Communication: Candidates must be able to communicate effectively in both academic and health care
settings. A candidate must be able to speak, to hear, and to observe patients by sight in order to elicit
information; describe changes in mood, activity and posture; and perceive nonverbal communication.
Candidates must show evidence of effective written and verbal communication skills.

Sensory & Motor: The ability to participate in basic diagnostic and therapeutic maneuvers and procedures (e. g.
palpation, auscultation) is required. Candidates must have sufficient motor function to execute movements
reasonably required to provide care to patients. Candidates must be able to negotiate patient care environments,
and must be able to move between settings, such as clinic, classroom buildings, and the hospital. Physical
stamina sufficient to complete the rigorous course of didactic and clinical study is required. Long periods of
sitting, standing, or moving are required in the classroom, laboratory, and clinical areas.

Intellectual: Candidates must be able to measure, calculate, reason, analyze, and synthesize. Problem solving,
one of the critical skills demanded of physician assistants, requires all of these intellectual abilities. In addition,
candidates should be able to comprehend three-dimensional relationships, and understand medical literature. In
order to complete the PA degree, candidates must be able to demonstrate mastery of these skills, and the ability
to use them in a timely and often critical fashion in medical problem solving and patient care.

Behavioral and Social Attributes: Candidates must possess the emotional health required for full utilization of
their intellectual abilities, the exercise of good judgment, and the prompt completion of all academic and patient
care responsibilities. The development of mature, sensitive and effective relationships with patients and other
members of the health care team are essential. The ability to effectively function in the face of uncertainties
that are inherent in clinical practice, along with flexibility, compassion, integrity, motivation, interpersonal
skills, and concern for all, is required. Any student with accessibility needs should contact Sandy Louden
before matriculation into the BCPA program. She can be reached at 731-352-4095 or at loudens@bethel-

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