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CALIFORNIA STATE UNIVERSITY, LONG BEACH RESEARCH FOUNDATION Voluntary Medical Disclosure Statement and Assumption of Risk Youth Activity: from, 2015 to, 2015. Participant: Age: First Last Middle The

How to fill out voluntary medical disclosure statement

How to fill out a voluntary medical disclosure statement:

1. Begin by carefully reading the instructions provided with the form. This will ensure that you understand the purpose of the statement and what information needs to be included.
2. Start by providing your personal information, such as your full name, date of birth, and contact details. This will help identify you and ensure the accuracy of the information provided.
3. Next, provide a detailed account of your medical history. Include any past or current medical conditions, surgeries, treatments, medications, allergies, and any ongoing or recent medical consultations.
4. Be thorough in your response, but also be mindful of relevant information. Only include details that are directly related to the purpose of the statement, such as conditions that may impact your ability to perform certain tasks or that may require accommodations in a specific setting.
5. It's important to include any mental health conditions or psychological disorders, as these can also have an impact on your overall health and well-being.
6. If applicable, include information about any ongoing or recent injuries that may require medical attention or accommodations.
7. Consider attaching relevant medical records or supporting documentation to verify the information provided. This can help ensure the accuracy and credibility of your disclosure.

Who needs a voluntary medical disclosure statement?

1. Individuals applying for a new job position may be required to complete a voluntary medical disclosure statement as part of the pre-employment process. This is usually to assess their medical fitness for the role or to determine if any reasonable accommodations need to be provided.
2. Students applying to educational institutions or participating in programs that involve physical activities may also need to fill out a voluntary medical disclosure statement. This is done to ensure their safety during these activities and to provide any necessary accommodations or modifications.
3. Individuals involved in athletic events or sports activities may be required to complete a voluntary medical disclosure statement. This is to ensure the safety of the participants and to help identify any potential health risks or conditions that may affect their ability to participate.

In summary, filling out a voluntary medical disclosure statement involves providing accurate and relevant details about your medical history, including any current or past conditions, treatments, and allergies. The statement is typically required for job applications, educational programs, and athletic events to assess medical fitness and determine necessary accommodations.

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