What lab tests are required for a medical certificate for a healthy adult or adolescent with no known medical history?

Lab Tests for Medical Certificate in Healthy Adults/Adolescents

For a healthy adult or adolescent with no known medical history seeking a routine medical certificate, no laboratory tests are routinely required unless specific clinical indications, risk factors, or occupational/insurance requirements dictate otherwise. 1, 2

Risk-Based Screening Approach

The modern standard of care emphasizes targeted testing based on individual risk factors rather than blanket laboratory panels:

• Healthy adolescents (ages 12-17) require no routine laboratory tests at annual examinations in the absence of specific risk factors or clinical symptoms 2
• Healthy adults without risk factors do not require routine comprehensive laboratory panels for standard medical certificates 1
• Laboratory testing should only be ordered when clinical indications are present, as ordering routine panels without justification leads to unnecessary costs, false-positive results, and patient anxiety 2

When Laboratory Tests ARE Indicated

Metabolic Risk Factors

If the individual has a BMI ≥25 kg/m² (adults) or ≥85th percentile (adolescents) with additional risk factors, screening becomes appropriate:

• Hemoglobin A1C or fasting glucose is recommended for diabetes screening when risk factors include: first-degree relative with diabetes, high-risk race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander), history of cardiovascular disease, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, polycystic ovary syndrome, or physical inactivity 1, 2
• For adults ≥35 years without risk factors, testing every 3 years is reasonable; for those with prediabetes (A1C 5.7-6.4%), annual testing is recommended 1

Age-Specific Considerations

• Adults ≥65 years: Consider thyroid-stimulating hormone (TSH), particularly in women, and functional performance assessment 1
• Men aged 65-75 who have ever smoked: One-time abdominal ultrasonography for abdominal aortic aneurysm screening 1

Medication-Specific Monitoring

• Vitamin B12 levels for patients on metformin 1, 3
• Serum potassium for patients on ACE inhibitors, ARBs, or diuretics 1, 3

Universal Requirements (Non-Laboratory)

Every medical certificate examination should include:

• Blood pressure measurement at every visit 1, 2, 3
• BMI calculation from height and weight measurements 1, 2, 3
• Physical examination including cardiovascular, respiratory, skin, and neurological components 2, 4

Occupation or Insurance-Specific Requirements

The specific purpose of the medical certificate may dictate additional testing:

• Certificates for insurance companies may require extended evaluations beyond routine screening 5
• Workers' compensation certificates may require specific diagnostic information related to injury or illness 6
• Driving license authorities (e.g., for diabetes patients) may require confirmation of stable metabolic control 5
• The certificate must clearly state the date of examination, period of fitness/unfitness, and any work restrictions without violating medical confidentiality 6

Common Pitfalls to Avoid

• Ordering comprehensive metabolic panels, complete blood counts, or lipid profiles without clinical indication in healthy individuals represents over-testing and should be avoided 2
• Failing to assess individual risk factors leads to both over-testing in low-risk patients and under-testing in high-risk patients 2
• Providing excessive diagnostic detail in certificates violates medical confidentiality; only information relevant to fitness for the stated purpose should be included 6
• Issuing certificates without direct examination of the patient is inappropriate and may constitute a legal offense in some jurisdictions 5, 7

Documentation Requirements

A valid medical certificate must include:

• Identity and credentials of the examining physician 5, 7
• Patient's identity 5, 7
• Date of examination 5, 6, 7
• Physician's signature 5, 7
• Specific period of fitness or restrictions, when applicable 6
• Purpose or addressee of the certificate 5