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HEALTH INFORMATION FORM PAGE 1 OF 4 PLEASE COMPLETE AND RETURN BY MAY 1 Arrival Date: Departure Date: Student Name LAST Birthdate / MONTH Gender / DAY Male FIRST MIDDLE Age YEAR Female *Last 4 digits
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Start by carefully reading the instructions provided on the form.
02
Fill in your personal information, such as your name, date of birth, and contact details, in the designated spaces.
03
Provide information about your medical history, including any pre-existing conditions, allergies, or medications you are currently taking.
04
If required, provide details of your previous medical examinations and tests.
05
Answer any specific questions related to your health, such as whether you smoke or consume alcohol.
06
If applicable, provide information about your family's medical history.
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Make sure to sign and date the form at the designated space.
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Review the completed form for any errors or omissions before submitting it.

Who needs 0689 health exam form:

01
Individuals who are applying for a job or a position that requires a health examination may need to fill out the 0689 health exam form.
02
Some educational institutions or programs may require students to submit a health exam form, including the 0689 form, prior to enrollment.
03
The 0689 form may also be required for certain insurance or visa applications that require proof of good health.
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The 0689 health exam form is a document used to report the results of a health examination.
Individuals who are required to undergo a health examination as part of their job requirement or for insurance purposes are required to file the 0689 health exam form.
The 0689 health exam form must be filled out by providing accurate information about the individual's health examination results, including any medical conditions or concerns.
The purpose of the 0689 health exam form is to document and report the results of a health examination for employment or insurance purposes.
The 0689 health exam form must include information about the individual's health examination results, including any medical conditions, test results, and recommendations from the healthcare provider.
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