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Route this form to:Extension of Maximum Period of Probationary Service for TenureTrack Faculty Caregiver or Personal Medical Illness/Injury or Other Wide Form UM 1765See Routing Instructions Below
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Start by providing your personal information such as your full name, date of birth, and contact details.
02
Fill out the section related to your medical history, including any pre-existing conditions or chronic illnesses.
03
Provide a detailed description of your current illness or injury, including the symptoms you are experiencing.
04
Include any relevant medical tests or treatments you have undergone or are currently undergoing.
05
Mention any medications you are currently taking for your illness or injury.
06
If applicable, provide the details of any healthcare professionals or specialists you have consulted for your condition.
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Finally, review the completed form for accuracy and make sure to sign and date it.
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Note: It is always recommended to consult with a medical professional or follow the guidelines provided by the specific medical institution while filling out personal medical illness/injury forms.

Who needs personal medical illnessinjury or?

01
Anyone who has experienced a personal medical illness or injury and requires medical attention should fill out a personal medical illness/injury form.
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This includes individuals seeking medical treatment, hospital admissions, insurance claims, or those participating in research studies or clinical trials.
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Whether it is a minor injury or a chronic condition, providing accurate and detailed information about the illness/injury is crucial for proper diagnosis, treatment, and care.
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Personal medical illness or injury is a report that documents any health issues or injuries that have occurred to an individual.
Any individual who has experienced a medical illness or injury is required to file a report.
To fill out a personal medical illness or injury report, one must provide details about the illness or injury, including symptoms, treatment received, and any impact on daily activities.
The purpose of personal medical illness or injury report is to document health issues and injuries for medical and legal purposes.
The report must include details about the illness or injury, date of occurrence, symptoms, treatment received, and any impact on daily activities.
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