Instead of a full exam report, a Nebraska examiner can certify on this short form that a student received the complete physical examination required for entry at the beginner grade, seventh grade or an out-of-state transfer (Neb. Rev. Stat. 79-214). It can also carry the visual evaluation results, and the parent consents to release it to the school.
The qualified medical examiner, a physician, physician assistant or APRN, completes Part I with the exam date, signature and printed name. The parent or guardian completes Part II, consenting to release to the named school.
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Certification of Physical Examination
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FH-42 is the full physical examination report with findings, hearing screening, medications and an athletics certification. FH-43 is a short certificate in which the examiner attests that the required complete physical was done on a stated date, with optional visual evaluation results.
The form quotes Nebraska Administrative Code Title 173: a signed form showing a physical examination was administered on a specific date within the previous six-month period, on a named individual, is sufficient evidence of an exam by a qualified examiner.
Part I is signed by the qualified medical examiner, which the form defines as a physician, physician assistant or advanced practice registered nurse. The examiner prints their name and adds an address or clinic stamp.