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Experiential Education Medical Form Johns Hopkins University 3400 North Charles Street Attn: Recreation Baltimore, MD 21218 phone: 4105164417 fax: 4105165376 email: op@jhu.eduDirections: To fill out
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Obtain the experiential education medical form from the appropriate organization or institution.
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Fill out your personal information, including name, date of birth, address, and contact information.
03
Provide information about your medical history, including any chronic conditions, allergies, or medications you are currently taking.
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Have a healthcare provider fill out the section for a physical examination, including vital signs and any recommendations for accommodations during the experience.
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Sign and date the form, acknowledging that the information provided is accurate and complete.
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Submit the completed form to the relevant person or organization as instructed.

Who needs experiential education medical form?

01
Students participating in experiential learning opportunities such as internships, clinical placements, or volunteer work.
02
Employees who are required to undergo medical screening for certain job roles or industries.
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Participants in research studies or clinical trials that require medical information for safety and monitoring purposes.
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Experiential education medical form is a document that collects medical information from individuals participating in educational programs that involve hands-on experiences in medical settings.
Individuals participating in educational programs that involve hands-on experiences in medical settings are required to file experiential education medical form.
Experiential education medical form can usually be filled out online or in person by providing accurate medical information and personal details.
The purpose of experiential education medical form is to ensure that individuals participating in educational programs in medical settings are medically fit to do so and to provide necessary medical information in case of emergencies.
Information such as medical history, allergies, current medications, emergency contacts, and any existing medical conditions must be reported on experiential education medical form.
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