PHS-1373 2002 free printable template
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The officer should send a photocopy of form PHS-1373 to his/her supervisor for completion of Parts B and C. PRIVACY ACT STATEMENT FOR FORM PHS-1373 SEPARATION OF COMMISSIONED OFFICER System of Records 09-40-0001 PHS Commissioned Corps General Personnel Records HHS/PSC/HRS. General This statement is provided pursuant to the Privacy Act of 1974 5 U.S.C. Department of Health and Human Services Public Health Service Commissioned Corps PHS-1373 Rev. 3/02 DATE RECEIVED IN DCP SEPARATION OF...
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How to fill out PHS-1373
01
Obtain a copy of the PHS-1373 form from the appropriate agency or website.
02
Fill out the personal information section accurately, including your name, address, and contact information.
03
Provide details regarding your health history, including any relevant medical conditions or treatments.
04
Answer any questions related to travel history, exposure to communicable diseases, or vaccination records.
05
Review the section on consent and ensure you understand the implications of your submission.
06
Sign and date the form at the specified area to certify the information is correct.
07
Submit the completed form via the designated method (online, by mail, etc.) as instructed.
Who needs PHS-1373?
01
Individuals applying for certain public health programs or services.
02
Healthcare professionals needing to document specific health information.
03
Organizations or agencies that must comply with health monitoring regulations.
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What is PHS-1373?
PHS-1373 is a specific form used for reporting health-related data as part of public health initiatives.
Who is required to file PHS-1373?
Entities or individuals involved in health-related activities that fall under public health regulations are required to file PHS-1373.
How to fill out PHS-1373?
To fill out PHS-1373, follow the instructions provided on the form, ensuring all sections are completed accurately with the required data.
What is the purpose of PHS-1373?
The purpose of PHS-1373 is to collect essential health information that assists in monitoring public health trends and issues.
What information must be reported on PHS-1373?
PHS-1373 requires reporting of demographic data, health condition details, and any relevant treatment information associated with the public health initiative.
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