Get the free Survivor Participant Medical Intakedoc - shelterincalpena

Shelter, Inc. Survivor×Participant Medical Intake Survivor×Participant Name: Household ID#: 1. Prescription Medications: (Indicate if ...

How to fill out survivor participant medical intakedoc

How to fill out survivor participant medical intake document:

1. Start by providing your personal information: Fill out your full name, date of birth, address, contact number, and emergency contact details. It is important to provide accurate information so that the organizers can reach out to you if needed.
2. Medical history: Answer the questions regarding your medical history honestly. Include any past surgeries, illnesses, allergies, or medications you are currently taking. This information is crucial for the organizers to ensure your well-being during the survivor participant program.
3. Current medical condition: Describe your current medical condition or any existing injuries or limitations that may affect your participation. This will help the organizers assess your suitability for certain activities within the program.
4. Insurance information: Provide details of your health insurance coverage, including the name of the insurance company, policy number, and contact information. This will ensure that you are adequately covered in case of any medical emergencies during the program.
5. Signature and date: Once you have completed all the sections of the intake document, sign and date it to confirm that the information provided is accurate to the best of your knowledge.

Who needs survivor participant medical intake document:

1. Individuals participating in the survivor program: Any individual who wishes to participate in the survivor program will need to fill out the medical intake document. This document serves as a tool for the organizers to assess the participant's medical history and current condition.
2. Organizers of the survivor program: The organizers will require participants to complete the medical intake document to ensure they have a comprehensive understanding of each participant's health status. This information will assist them in providing appropriate care and making necessary accommodations during the program.
3. Medical personnel: Medical personnel involved in the survivor program, such as doctors or nurses, may need access to the medical intake document to understand the participant's health background. This can help them provide specialized care or assistance if required.

In summary, filling out the survivor participant medical intake document accurately and honestly is essential for both the individuals participating in the program and the organizers. It helps ensure the participant's safety and allows the organizers to make necessary arrangements based on their medical history and current condition.

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