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This document is a patient information form used by the Student Health and Counseling Center for collecting immunization records and obtaining consent for treatment at California State University,
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How to fill out Student Health and Counseling Center Immunization Patient Information Form
01
Obtain the Student Health and Counseling Center Immunization Patient Information Form from the institution's website or health center.
02
Fill in your personal information at the top of the form, including your name, student ID, date of birth, and contact information.
03
List your immunization history on the designated section of the form, including specific vaccines received and dates administered.
04
If applicable, provide information about any allergies or medical conditions relevant to your health.
05
Carefully review the completed form for accuracy and completeness.
06
Sign and date the form to certify that the information provided is true and accurate.
07
Submit the form to the Student Health and Counseling Center by the specified deadline, either in person or via the designated submission method.
Who needs Student Health and Counseling Center Immunization Patient Information Form?
01
All incoming students who are required to provide proof of immunization as part of their enrollment process.
02
Students who plan to participate in health programs or activities that necessitate up-to-date immunization records.
03
Students transferring from other institutions who need to document their immunization history.
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Who can fill out my immunization form?
Should students or student health offices complete the form? Students should complete the AAMC Standardized Immunization Form in conjunction with either the student health office at their medical school or with their primary care provider.
Why is UPenn so prestigious?
The Coverdell Fellowship at the University of Pennsylvania's Master of Public Health (MPH) program provides students with unique, interdisciplinary training. Students will get broad public health training, while also expanding their global health skills and experiences.
Does UPenn have an urgent care?
Penn Medicine OnDemand providers are available all day, every day, ensuring your urgent, non-emergency medical needs can be addressed even when your primary care doctor's practice is closed.
What is the immunization form?
We recommend one of the following Emergency Departments: Hospital of the University of Pennsylvania (HUP)(link is external) – 1 Convention Avenue, Philadelphia. Penn Presbyterian Medical Center (PPMC) (link is external)– Myrin Building, 51 N. Pennsylvania Hospital (PAH)(link is external) – 800 Spruce Street, Philadelphia.
Where to go if sick in UPenn?
Call Student Health and Counseling at 215-746-WELL (9355) to schedule.
Does UPenn have a Hospital on campus?
Through the Pavilion, patient care at the Hospital of the University of Pennsylvania (HUP) is being brought to new levels. We have transformed how we organize and deliver care, using state-of-the-art technology and new ways of thinking to ensure the patient experience is at the very center of everything we do.
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What is Student Health and Counseling Center Immunization Patient Information Form?
The Student Health and Counseling Center Immunization Patient Information Form is a document used by educational institutions to collect and maintain records of students' immunization history.
Who is required to file Student Health and Counseling Center Immunization Patient Information Form?
Students who are enrolling in the institution, particularly those residing on campus or participating in specific programs, are required to file the Student Health and Counseling Center Immunization Patient Information Form.
How to fill out Student Health and Counseling Center Immunization Patient Information Form?
To fill out the form, students should provide accurate personal details, submit documentation of vaccinations received, and ensure all sections are completed and signed as necessary.
What is the purpose of Student Health and Counseling Center Immunization Patient Information Form?
The purpose of the form is to ensure that students meet immunization requirements for public health and safety and to keep comprehensive health records for each student.
What information must be reported on Student Health and Counseling Center Immunization Patient Information Form?
The form must report personal identification information, details of immunizations received, including dates and types of vaccines, and any medical exemptions if applicable.
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