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THE UNITED METHODIST CHURCHMEDICAL SUMMARY REPORT OF MINISTERIAL CANDIDATEForm 103Candidate�s Name: _____________________________________________________________To the Board of Ordained Ministry:
CONSENT FOR THE RELEASE OFCONFIDENTIAL INFORMATION � COMPLETED BY CANDIDATE
SUMMARY REPORT � COMPLETED BY PHYSICIANComments for physician:
Candidate�s Name:Date of Physical Exam:Check One:
Summary of Concerns:
Typical treatment(s) for this condition could potentially include (medication, surgery, lifestylemodification, intervention by specialist, frequent monitoring, etc.):
Questions to ask, or conversation that a committee might have, to address these concerns couldinclude:
EXAMINATION STANDARDS*
The Book of Discipline
NOTE: DO NOT RECORD SCREENING RESULTS ON THIS FORM.Screening
Counseling�Substance Abuse
Counseling�Diet and Exercise
Key Points
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