Get the free STUDENT HEALTH SERVICES RECORD - Lakeland College

STUDENT HEALTH SERVICES RECORD PERSONAL INFORMATION SURNAME: FIRST NAME: INITIAL: ADDRESS: TELEPHONE: DATE OF BIRTH: SEX: M F HEALTH CARE NUMBER: PROVINCE: PROGRAM OF STUDY: CAMPUS: NEXT OF KIN NAME:

How to fill out student health services record

How to fill out a student health services record:

1. Gather necessary information: Before starting the form, make sure you have the required information handy such as your personal details, emergency contact information, and medical history.
2. Personal details: Begin by filling out your personal information including your full name, date of birth, gender, and contact details.
3. Emergency contact information: Provide the name, phone number, and relationship of someone who can be contacted in case of an emergency.
4. Medical history: Fill out the medical history section accurately, listing any past illnesses, surgeries, allergies, or chronic conditions you have or have had in the past.
5. Current medications: Include a list of all the medications you are currently taking, including dosage and frequency.
6. Immunization record: Provide details of your immunization history, including the dates and types of vaccines you have received.
7. Insurance information: If applicable, provide your insurance details, including your insurance provider and policy number.
8. Consent, authorization, and signature: Read through the form carefully, ensuring you understand and agree to all the terms and conditions. Sign and date the form as required.
9. Submit the form: Once you have completed the form, submit it to the student health services office or follow the instructions provided.

Who needs a student health services record?

1. All students: It is typically required for all students to fill out a student health services record, regardless of their age or program of study.
2. New students: Freshmen or students newly enrolling in a university or college often need to complete a health services record as part of the enrollment process.
3. Student-athletes: Athletes participating in intercollegiate or intramural sports programs usually need to submit a student health services record to ensure they are medically fit to participate.
4. Students in health-related programs: Students pursuing health-related degrees such as nursing or medicine may be required to provide more comprehensive health information as part of their program requirements.
5. International students: International students may need to provide a health services record as part of their immigration or visa requirements.
6. Students needing special accommodations: Students with specific medical or disability-related needs may be required to complete additional health forms to ensure the appropriate support and accommodations are provided.

In summary, filling out a student health services record requires gathering the necessary information, providing personal details, emergency contact information, medical history, current medications, immunization records, insurance details, giving consent and authorization, and finally submitting the form. This record is typically required for all students, particularly new students, student-athletes, those in health-related programs, international students, and students needing special accommodations.

For pdfFiller’s FAQs

What is student health services record?

Student health services record is a document that contains information about a student's health history, medications, allergies, and any medical treatments they have received.

Who is required to file student health services record?

All students are required to file student health services records, especially those attending educational institutions.

How to fill out student health services record?

Students can fill out student health services records by providing accurate and up-to-date information about their health history, medications, allergies, and medical treatments.

What is the purpose of student health services record?

The purpose of student health services record is to ensure that students receive appropriate medical care and treatment while at school, and to keep a record of their health history for future reference.

What information must be reported on student health services record?

Student health services records must include information about the student's health history, medications, allergies, and any medical treatments they have received.

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