Get the free Refugee Health Assessment Form - Florida Department of Health

Attachment B REFUGEE HEALTH ASSESSMENT MEDICAL HISTORY & OVERSEAS MEDICAL RECORD INFORMATION (Maybe documented on approved DOH forms (e.g., progress notes, adult screening form, or school physical)

How to fill out refugee health assessment form

How to fill out refugee health assessment form:

1. Start by carefully reading all the instructions provided with the form. Make sure you understand the purpose of each section and the information that is required.
2. Begin with the personal information section. Provide accurate details such as your name, date of birth, country of origin, and any other requested demographics.
3. Move on to the medical history section. Be thorough and honest when answering questions about your previous medical conditions, surgeries, or chronic illnesses. If you have any current medications or allergies, make sure to mention them as well.
4. Next, fill out the immunization history section. List all the vaccinations you have received in the past, including the dates if possible. If you are unsure about your immunization records, consult with a healthcare professional.
5. In the mental health section, disclose any psychological or emotional concerns you may have experienced in the past or are currently facing. It is essential to provide accurate information to ensure appropriate care and support.
6. If applicable, complete the reproductive health section. This may include questions related to pregnancies, contraception methods used, and any specific reproductive health concerns.
7. Provide consent for sharing information section, where you authorize the release of your medical records for the purpose of the refugee health assessment. Make sure to understand the implications of this consent and ensure your privacy preferences are respected.
8. Finally, carefully review your form before submitting it. Double-check for any inaccuracies or missing information. Seek assistance from a healthcare professional or interpreter if needed.

Who needs a refugee health assessment form?

1. Individuals who are seeking refugee status or have recently been granted refugee status in a new country typically need to complete a refugee health assessment form.
2. The purpose of this form is to gather relevant medical information to ensure appropriate healthcare and support for refugees. It allows healthcare providers to understand the medical history, immunization status, mental health concerns, and reproductive health needs of the individual.
3. By completing the refugee health assessment form, refugees enable healthcare professionals to create a comprehensive healthcare plan and address any specific health needs or challenges they may face as a result of their displacement and migration.

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