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IS Teen (FIFTEEN) Hard Copy Questionnaire Q3/2021 Section S Screener Section B No Shot Records Section C Demographics Section D Provider Section E Health Insurance Module Confidential Information
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How to fill out traditional undergraduate health form

01
Obtain a copy of the traditional undergraduate health form from your college or university.
02
Fill in your personal information such as name, date of birth, and contact information.
03
Provide details of your medical history including any pre-existing conditions or medications you are currently taking.
04
Complete the section on immunizations by listing the dates and types of vaccines you have received.
05
If necessary, have your healthcare provider fill out the sections related to physical exams and medical clearances.
06
Sign and date the form to certify that the information provided is accurate.
07
Submit the completed form to the designated office or department at your college or university.

Who needs traditional undergraduate health form?

01
Traditional undergraduate students who are attending college or university.
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The traditional undergraduate health form is a document that gathers health information from students attending a college or university.
All traditional undergraduate students are required to file the health form.
To fill out the traditional undergraduate health form, students need to provide information about their medical history, current health status, and any vaccinations they have received.
The purpose of the traditional undergraduate health form is to ensure that students are healthy and well-prepared to participate in campus activities.
Information such as medical history, current health conditions, allergies, medications, and vaccination records must be reported on the traditional undergraduate health form.
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