(a) The physical examination prescribed by the State Board pursuant to Education Code Section 44839.5 is an examination by a physician and surgeon licensed to practice in California that will enable the examining physician and surgeon to ascertain whether or not the person is free from infection or contagious disease, including an examination for tuberculosis made in the manner described in Education Code Section 49406.
The physician's certificate, showing that the employee was examined and that the person was found free from active tuberculosis and from any other contagious or infectious disease, shall be filed with the county superintendent of schools and a duplicate or photographic copy shall be filed with the employing school district. A notice from a public health agency or unit of the Tuberculosis Association that indicates freedom from active tuberculosis may be substituted for that part of the physicians certificate relating to tuberculosis. The examination shall have been made within six months of filing of the completed certificate with both the county superintendent of schools and employing school district.
(b) The certificate shall be in substantially the following form:
CERTIFICATION OF FREEDOM FROM CONTAGIOUS OR INFECTIOUS DISEASE
I hereby certify that:
(1) I am licensed to practice as a physician and surgeon in California.
(2) On the date shown hereinbelow I examined, who gave as his (her) date of birth __________ and as his (her) address ________________. On that date I found him (her) to be free from any contagious or infectious disease including freedom from active tuberculosis.
Date_____________, 19___
Physician and Surgeon_________________________
The following authorization signed by the person examined shall be set forth below the certificate:
Dr.______________:
You are hereby authorized to give to the State Board of Education, any county superintendent of schools, the governing board of a school district to which the undersigned has applied for employment, and representatives of any of them, any and all information you may have regarding my physical or mental condition, including but not being limited to the history, findings, diagnosis, treatment given, present condition, and prognosis.
Date _________ 19 _
______________ Signature of Person Examined
Authority cited:
Education Code 44839.5
Reference:
Education Code 44839.5
(Amended by Register 80, No. 42.)