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Internship/Shadowing Associate Health Clearance Form Section ATO BE COMPLETED BY REQUESTOR/APPLICANTAssociate Health & Wellness 169 Riverside Drive Binghamton, NY 13905 6077985552 Fax 6077986759 Email:
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How to fill out internshipshadowing associate health clearance

01
To fill out the internshipshadowing associate health clearance form, follow these steps:
02
Gather all necessary personal information, such as full name, date of birth, and contact details.
03
Provide details about the internship or shadowing program you will be participating in, including the name of the organization or facility.
04
Complete the medical history section by providing accurate information about any past or current medical conditions, surgeries, or hospitalizations.
05
Answer questions regarding immunizations and vaccinations, ensuring you provide the dates and types of vaccines received.
06
If applicable, provide details about any allergies or medication you are currently taking.
07
Sign and date the form.

Who needs internshipshadowing associate health clearance?

01
Anyone who wishes to participate in an internship or shadowing program as an associate typically needs to fill out the internshipshadowing associate health clearance form.
02
This form ensures that individuals are in good health and able to engage in the activities required for the internship or shadowing experience.
03
It is typically required by the organization or facility providing the internship or shadowing opportunity to ensure the safety and well-being of all participants.

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