What Is a Medical Evaluation?

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  • Written By: C. Webb
  • Edited By: Daniel Lindley
  • Last Modified Date: 14 January 2020
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A medical evaluation is a process during which a health care professional examines the patient's body for signs of injury, illness, or disease. Some medical evaluations are with a primary care physician due to patient symptoms. Third-party physicians sometimes are requested to verify previously diagnosed medical issues.

Most medical evaluations begin with a medical history. The patient is asked about currently prescribed medications, current and past medical conditions, surgeries, and illnesses. Vital signs, including blood pressure, heart rate, and body temperature, are taken and recorded. Symptoms are discussed as to onset and severity.

The body is examined. This can include testing physical reflexes, examining the eyes, nose, and throat, or visually checking injuries. Based on symptoms and examination findings, further tests may be ordered. Blood tests, x-rays, or tests of the cardiovascular system are examples of commonly requested tests for a medical evaluation. Based on examinations and test results, the diagnosis is made.

Medical evaluations ordered by insurance companies or employers typically target previously diagnosed conditions. For example, a claim of a work-related injury by an employee is examined to assess the injury's existence or severity. In addition, the medical evaluation is used to rate the severity of injury or illness to determine a financial award or disability payment duration.


Some medical evaluations are ordered to support a plaintiff or defendant in a civil lawsuit. When this happens, the existence and probable cause of a specific injury or illness is evaluated. The medical evaluation results are provided to the requesting party. In some cases, the evaluating physician is required to testify in court as to his or her findings and expert opinions regarding those findings.

An insurance company will also sometimes pay for a medical evaluation as a preventative health care measure. Policy holders are encouraged to schedule a medical evaluation so that illnesses or injuries can be detected and treated in their early stages. Such evaluations usually involve a complete physical examination. Insurance companies order medical evaluations to assess customer insurance eligibility. Denial of eligibility or a higher premium can result from the evaluation results.

Gender-specific tests are typically included in a general medical evaluation. Pap smears and prostate exams are examples of gender-specific testing. In addition, pregnancy testing during a basic physical check-up is reserved for female patients within a targeted age range.


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