Clipboard Health Physical Exam Form: Signers, Upload, and Fees

Before you can book shifts through Clipboard Health, you need to upload a completed Clipboard Health physical exam form signed by a qualified provider. The blank template lives in the Documents section of the app. Print it, take it to an MD, DO, nurse practitioner, or physician assistant, and upload a clear photo of the signed form back through the same section. Most partner facilities want the exam dated within the last twelve months, so plan on renewing it every year.

Where to Get the Blank Form

Open the Clipboard Health mobile app and go to your compliance Documents. Look for the physical exam category and download or screenshot the blank template from there. Use this template rather than a generic form from your doctor’s office. The compliance team reviews submissions against a specific layout, and a form missing fields Clipboard Health checks for is one of the fastest ways to get bounced back.

If the template isn’t showing up, message support through the in-app chat. That team handles document questions, upload trouble, and rejection follow-ups.

What Happens at the Appointment

The exam is a standard occupational physical. Your provider records baseline biometrics such as blood pressure, heart rate, and respiratory rate, and fills in identifying details for you and for themselves. Print everything clearly. Illegible entries are one of the most common reasons submissions get rejected.

Mention that the exam is for clinical shift work. Some facilities want documentation that you can handle the physical demands of nursing, including lifting, repositioning patients, and standing for long periods, and your examiner may want to note that on the form.

Tuberculosis Screening

TB screening is a separate but connected requirement. The CDC recommends that all healthcare personnel be screened at hire, using either a TB blood test such as QuantiFERON-TB Gold or a TB skin test (the PPD/Mantoux method).1Centers for Disease Control and Prevention. Clinical Testing Guidance for Tuberculosis: Health Care Personnel Use whichever test your provider offers.

If you have a documented positive TB test in your history, you don’t need to be retested. The CDC calls for a symptom screen instead, with further evaluation (usually a chest X-ray) only if symptoms are present.2Centers for Disease Control and Prevention. Frequency of Tuberculosis Screening and Testing for Health Care Personnel Bring the prior positive result and any past chest X-ray with you so the provider can note your status without ordering repeat testing.

Immunization Records to Bring

Partner facilities expect proof of immunity for several vaccine-preventable diseases.3Centers for Disease Control and Prevention. Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC) Gather these before your appointment so the provider can transcribe them onto the form:

Bring vaccination cards, pharmacy printouts, or prior titer results. If records are missing, a blood titer can confirm immunity for MMR, varicella, and hepatitis B without repeating the vaccine series, though titers add cost and a second visit for results.

Who Is Allowed to Sign It

The form must be signed by a provider with authority to conduct independent medical examinations. MDs and DOs qualify in every state. Nurse practitioners and physician assistants can also sign, as long as they’re practicing within their scope of authority under state law.6The Joint Commission. History and Physicals – Understanding the Requirements Any urgent care or occupational health clinic will have someone eligible on staff.

RNs, LPNs, and other clinical staff without independent examination privileges cannot sign this form, even as a favor. The compliance team gives no flexibility here. An unauthorized signature means automatic rejection and possibly a review of your account. Make sure the signing provider adds their printed name, credentials, and signature. If the form has a field for a license number or practice contact information, fill that in too.

How to Upload It

Go back to the Documents section in the app, select the physical exam category, and either photograph the signed form directly through the app or upload a saved PDF or image. To keep the upload from bouncing back:

  • Show all four corners of the page, with sharp text and no shadows over the signature or date.
  • Upload to the correct document category. The wrong category sends the file to the wrong review queue and adds days to your wait.
  • Confirm every field is filled in before you submit, especially the exam date. A missing date is the single most common reason forms get kicked back.

The compliance team usually reviews submissions within one to two business days. You’ll see an in-app notification confirming approval or explaining a rejection. Your shift eligibility stays active only once the document is marked verified, so don’t leave this to the day before a shift.

Save a copy of every signed form for yourself, either as a phone photo or a PDF in cloud storage. If an upload is lost or you move to a different platform later, having the original saves repeating the entire appointment.

Why Forms Get Rejected

Rejections come from concrete, fixable problems. The usual ones:

  • Missing or illegible signature. If the pen barely marked the page, ask the provider to sign again in darker ink.
  • Exam date older than twelve months at the time of upload.
  • Blank fields, especially the exam date, provider credentials, or biometric readings. A skipped blood pressure entry is enough to trigger a flag.
  • Wrong form. A generic physical from a doctor’s office may not include every field the Clipboard Health template has.
  • Poor image quality: blurry photos, cut-off edges, or shadows across the signature.

The rejection notice in the app usually names the exact problem. Fix it and resubmit. You don’t necessarily need a whole new exam if the issue was image quality or a missing initial.

What You’ll Pay

Clipboard Health does not reimburse the cost of the physical. A standard occupational physical at an urgent care or walk-in clinic typically runs $75 to $150, with prices varying by location and provider. Add-ons push the total higher. As a rough benchmark from one urgent care system: a PPD skin test around $35, a chest X-ray around $110, and basic lab panels around $30 each. Shopping between urgent care clinics, community health centers, and your primary care office can make a real difference, especially if you need several add-ons.

If your health insurance covers annual wellness visits, call ahead to ask whether the plan also covers an occupational physical or the associated lab work. Plans treat them differently, so don’t assume.

Don’t Falsify Any Part of It

Filling in a signature yourself, altering a date, or fabricating vaccination records carries consequences well beyond losing platform access. Under 18 U.S.C. ยง 1035, knowingly making false statements in connection with healthcare services is a federal crime punishable by up to five years in prison, a fine, or both.7Office of the Law Revision Counsel. 18 USC 1035 – False Statements Relating to Health Care Matters State licensing boards can also suspend or revoke your professional license over fraudulent documentation. Doing the exam legitimately costs a couple of hours and a modest fee. It’s not worth the alternative.