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EMPLOYEE/STUDENT HEALTH Jacobsen Hall 4TH Floor 750 East Adams Street, Syracuse, NY 13210 3154644260 (telephone) 3154645471 (fax) www.upstate.edu/healthTO:Incoming ResidentsFROM:Jarrod L. Bagatelle,
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How to fill out employeestudent health
01
Get the employeestudent health form from the HR department.
02
Read the instructions carefully before filling out the form.
03
Provide your personal details such as name, date of birth, and contact information.
04
Fill in the employment details accurately, including your job title and department.
05
Fill out the student details if applicable, such as the name of the educational institution and the course you are enrolled in.
06
Provide accurate information about your health history, including any pre-existing medical conditions.
07
Fill out the insurance section if required, providing details of your insurance provider.
08
Review the completed form for any errors or missing information.
09
Sign and date the form.
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Submit the filled-out employeestudent health form to the HR department.
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Keep a copy of the form for your records.
Who needs employeestudent health?
01
Employeestudent health is needed by employees who are also students or who have dependents enrolled as students.
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It is especially important for individuals who require access to healthcare services through their employment or educational institution.
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Employeestudent health can provide coverage for medical expenses, prescription medications, and other healthcare needs.
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