What is the purpose of a medical clearance note and how is it obtained?

The Purpose and Process of Medical Clearance Notes

A medical clearance note is a formal documentation that confirms a patient is medically stable to participate in a specific activity, procedure, or transfer to another facility, focusing primarily on assessing and minimizing risks to morbidity, mortality, and quality of life.

Definition and Purpose

• A medical clearance note serves to document that a patient has been evaluated and deemed medically stable for a specific purpose, such as transfer to a psychiatric facility, participation in sports or camp activities, air travel, or undergoing a procedure 1, 2
• The primary goal is not simply "clearing" a patient but conducting a comprehensive risk assessment to promote patient engagement and facilitate shared decision-making 2
• The term "medical clearance" can be misleading; the focus should be on determining "medical stability" rather than implying all potential medical conditions have been ruled out 1, 3

When Medical Clearance Is Required

• For patients with psychiatric conditions requiring transfer to mental health facilities 1, 4
• For individuals with medical conditions who wish to participate in sports, camps, or other physical activities 1
• For air travel, especially for patients with cognitive impairment, respiratory conditions, or other medical issues that may be affected by cabin pressure and environment 1, 5
• Before procedures such as endoscopy or surgery 1, 2
• For special populations requiring specific accommodations, such as children attending camps for those with chronic illnesses 1

Components of a Medical Clearance Note

Essential Patient Information

• Patient demographics and identification (name, address, contact information) 6
• Age and weight 6
• Name of the patient's personal care provider or medical home 6

Vital Signs and Physical Assessment

• Complete vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation, temperature) 6
• Documentation if vital signs cannot be obtained due to patient non-cooperation 6
• Focused physical examination of body systems relevant to the patient's condition 6

Medical History

• Allergies and previous adverse drug reactions 6
• Medication history (prescription, over-the-counter, supplements) 6
• Relevant diseases and physical abnormalities 6
• Pregnancy status for females of childbearing age 6
• History of seizure disorders and previous relevant hospitalizations 6

Risk Assessment

• For surgical clearance: cardiac risk using tools like the revised Lee cardiac risk index 2
• For psychiatric patients: assessment for medical conditions that could present as psychiatric symptoms 1
• For travel clearance: evaluation of conditions that may worsen with hypoxemia or cabin pressure changes 1, 5

Assessment and Plan

• Documentation of positive findings noted during evaluation 6
• Clear management plan addressing identified risks 6
• Specific recommendations for the receiving facility or activity organizers 1

How to Obtain a Medical Clearance Note

1. Schedule an appointment with an appropriate healthcare provider:

   • Primary care physician for general clearance 6
   • Specialist for condition-specific clearance (e.g., cardiologist for cardiac conditions) 2

2. Prepare necessary information:

   • Complete health history 6
   • List of current medications 6
   • Details about the specific activity or procedure requiring clearance 1, 2

3. Undergo appropriate evaluation:

   • Physical examination focused on relevant body systems 6
   • Laboratory tests as indicated by history and physical (not routine batteries of tests) 1, 7
   • Specialized testing if indicated (e.g., ECG for cardiac risk) 2

4. Receive documentation:

   • Written clearance note with specific recommendations 6
   • Forms specific to the receiving facility or organization 1
   • For airlines: Special Assistance Form (SAF) and Medical Information Form (MEDIF) for those requiring clearance 1

Special Considerations

For Psychiatric Patients

• Focus on determining whether psychiatric symptoms are caused or exacerbated by underlying medical conditions 1
• History and physical examination have sensitivities of 94% and 51% respectively for identifying medical problems in psychiatric patients 7
• Universal laboratory and toxicologic screening of all psychiatric patients has low yield; targeted testing based on history and physical is more appropriate 7

For Travel Clearance

• Patients with cognitive impairment may require special accommodations during air travel 1, 5
• Absolute contraindications to air travel include active infectious tuberculosis, current closed pneumothorax, and major thoracic surgery within 6 weeks 5
• For patients with respiratory conditions, medication adjustments based on time zone changes may be necessary 1, 5

For Children and Camps

• Preadmission medical requirements should be discussed before enrollment 1
• Action plans for chronic conditions (asthma, diabetes, allergies) should be provided to camp staff 1
• Elective interruption in medications should be avoided for children on long-term therapy 1

Common Pitfalls to Avoid

• Viewing medical clearance as simply "giving permission" rather than a comprehensive risk assessment 2, 3
• Performing unnecessary tests that will not influence management decisions 2, 7
• Failing to communicate findings and recommendations to all members of the care team 2
• Underestimating the stress of activities like air travel on patients with cognitive impairment 1, 5
• Not accounting for medication adjustments across time zones or during activities 1

Emergency Situations

• In emergencies, verbal consent for procedures may be used but must be fully documented 1
• When written or verbal consent cannot be obtained, the action taken must be the least restrictive of the patient's future options 1

By understanding the purpose and process of obtaining a medical clearance note, patients and healthcare providers can ensure appropriate evaluation and risk assessment before participating in activities or procedures that may impact health outcomes.