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DERBY HIGH SCHOOL 20202021 Nurse Emergency Medical Form and OTC Medication Authorization **Confidential** Student Name Male/FemaleGrade Home Addressable of Birthmark/Guardian Info: Name Cell Number:
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How to fill out dhs emergency medical form

01
To fill out the DHS emergency medical form, follow these steps:
02
Start by providing your personal information, including your full name, address, and contact details.
03
Next, indicate your emergency contact information, including their name, relationship to you, and contact numbers.
04
Provide your medical history, including any pre-existing conditions, allergies, and past surgeries or hospitalizations.
05
Specify your current medications, dosage, and frequency of use.
06
Describe any known allergies or adverse reactions to medications.
07
Indicate if you have any specific dietary requirements or restrictions.
08
Provide your primary healthcare provider's information, including their name, address, and contact details.
09
Mention any insurance coverage you have and provide the necessary details.
10
Sign and date the form to confirm the accuracy of the provided information.
11
Make sure to review the completed form for any errors or missing information before submitting it.
12
Note: The specific sections and requirements of the DHS emergency medical form may vary depending on the purpose and location.

Who needs dhs emergency medical form?

01
The DHS emergency medical form may be required by individuals who are:
02
- Applying for government-assisted healthcare programs
03
- Enrolling in a specific medical facility or program
04
- Traveling abroad and need to provide medical information
05
- Participating in high-risk activities or events where access to medical information is essential
06
- Required by their employers for emergency preparedness
07
It is advisable to contact the specific entity or organization that requires the form to determine if you need to provide it.
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The DHS emergency medical form is a document used to collect medical information in case of an emergency.
All individuals under the jurisdiction of DHS are required to file the emergency medical form.
The DHS emergency medical form can be filled out online or on paper by providing accurate and up-to-date medical information.
The purpose of the DHS emergency medical form is to ensure that individuals under the jurisdiction of DHS receive appropriate medical care in case of an emergency.
The DHS emergency medical form requires information such as medical history, allergies, medications, and emergency contacts.
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