Employee Medical Protocol Forms
The Code of Iowa provides for the creation and administration of a disability program for fire fighters and police officers covered by Iowa Code Chapter 411. The statute authorizes the retirement System’s Board of Trustees to select a medical board [411.5(8)] and to implement various program requirements, as follows:
- Creation of a statewide network for conduct of the entrance medical examinations for fire fighters and police officers, in consultation with the Medical Board. [411.5(8)] Effective January 1, 2005.
- Establishment of a wellness guideline for dissemination to the employing cities, for consideration as a voluntary program, which is subject to collective bargaining. [Iowa Code 400.8A]
- Formulation of revised protocols for pre-employment medical examinations for police officers and fire fighters. [400.8] Effective January 1, 2005.
The program documents, which describe its various components, are available within this web-site, as outlined below.
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- Instruction Memorandum to Employers
- Fee Schedule
- List of Network Clinics
- List of Chapter 411 Participating Cities
- Wellness Guideline
- Medical History Questionnaire Form (Applicant Completes)
- Occupational History Questionnaire Form (Applicant Completes)
- Medical Examination Form (Physician Completes)
- Medical Examination Protocol
- Protocol Summary Checklist