NorthShore University HealthSystem Travel Health History 2011 free printable template
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Enclosed is a brief description of our services along with a Travel History Form. Please complete the form according to the instructions and return it to us by fax 847-657-1759 preferred emailed to hperryman northshore. org or drop it off at our office. A separate form is required for each individual traveler. Please be sure the forms are completed and signed before returning them. Incomplete forms may delay processing. All travelers health histories must be reviewed by our clinical personnel...
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How to fill out northshore travel health history
How to fill out northshore travel health history?
01
Visit the website of Northshore Travel and find the "Health History" section.
02
Download the Northshore Travel Health History Form.
03
Fill in your personal information such as your name, address, phone number, and date of birth.
04
Provide details of your previous medical conditions and any ongoing treatments or medications.
05
Answer questions about your immunization history, including specific vaccines received and dates.
06
Declare any allergies or adverse reactions to medications or vaccines.
07
Mention if you have a pre-existing medical condition or chronic illness.
08
Indicate if you are currently pregnant or planning a pregnancy.
09
Describe any recent exposure to contagious diseases or travel to high-risk areas.
10
Sign and date the form, confirming that all the information provided is accurate and complete.
Who needs northshore travel health history?
01
Individuals planning to travel internationally.
02
Those visiting areas with a higher risk of infectious diseases.
03
People with pre-existing medical conditions or chronic illnesses.
04
Individuals who may require specific immunizations or medications for their travel destination.
05
Pregnant women or those planning a pregnancy.
06
Individuals with a history of allergies or adverse reactions to medications or vaccines.
07
Those who have recently been exposed to contagious diseases.
08
Anyone seeking comprehensive medical care before and during travel.
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What is northshore travel health history?
Northshore travel health history is a form that collects information about an individual's health history when traveling to Northshore.
Who is required to file northshore travel health history?
All individuals traveling to Northshore are required to file northshore travel health history.
How to fill out northshore travel health history?
Northshore travel health history can be filled out online by providing accurate and detailed information about your health history.
What is the purpose of northshore travel health history?
The purpose of northshore travel health history is to assess the health risks associated with travelers entering Northshore and to ensure appropriate measures are taken to protect the health and safety of the population.
What information must be reported on northshore travel health history?
On northshore travel health history, you must report information such as your medical conditions, vaccination history, recent travel history, and any symptoms related to infectious diseases.
When is the deadline to file northshore travel health history in 2023?
The deadline to file northshore travel health history in 2023 has not been specified. Please check the official website or contact the relevant authorities for the most up-to-date information.
What is the penalty for the late filing of northshore travel health history?
The penalty for the late filing of northshore travel health history may vary and is subject to the rules and regulations set by the authorities. It is advised to comply with the specified deadlines to avoid any potential penalties.
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