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Good Samaritan College of Nursing and Health Science Self Health Assessment Form PLEASE PRINT Name: Date: Address: Phone: () (Street) (City) Date of Birth: / / (State) (Zip) Age: Social Security #;
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What is self health assessment form?
Self health assessment form is a document where individuals can report their health status, symptoms, and any potential exposure to illnesses.
Who is required to file self health assessment form?
Anyone who is asked to complete the form by their employer, healthcare provider, or government authority.
How to fill out self health assessment form?
Fill out the form honestly and accurately, providing details about your health status, symptoms, and any potential exposure to illnesses.
What is the purpose of self health assessment form?
The purpose is to monitor and track individuals' health status and potential exposure to illnesses in order to prevent the spread of diseases.
What information must be reported on self health assessment form?
Information such as health status, symptoms, recent travel history, and any contact with sick individuals.
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