TX HHS Form 3104. General Physical Examination Report

The TX HHS Form 3104, General Physical Examination Report, is a crucial document that helps solve the problem of determining eligibility for rehabilitation services. This form is typically filled out by healthcare professionals or counselors in situations where an individual requires rehabilitation services due to a reported disability.

This report requires specific information, including patient demographics, medical history, and physical examination findings. The form asks for details such as date of birth, social security number, height, weight, blood pressure, and vision acuity (with glasses if available). Additionally, the report requests a condensed medical history, describing any abnormalities or conditions that may impact rehabilitation plans.

The information gathered on this form is essential in helping counselors develop an effective plan for rehabilitation services. Key features of this report include:

• A comprehensive patient profile
• A detailed medical history and physical examination findings
• Information necessary to determine eligibility for rehabilitation services