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IMMUNIZATION
HISTORY FORM
Basic Instructions:PLEASE PRINTStudents in ALL programs of
study are required to provide this
signed form, along with
immunization materials after
acceptance and prior to
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How to fill out health history and immunization
How to fill out health history and immunization
01
Gather necessary documents such as health history form and immunization records.
02
Fill out the health history form completely and accurately with information about medical conditions, allergies, medications, and previous surgeries.
03
Provide your immunization records, including dates and types of vaccines received.
04
Submit the completed forms to your healthcare provider or school nurse.
Who needs health history and immunization?
01
Everyone should have a health history and immunization records on file to ensure proper medical care and prevent the spread of contagious diseases.
02
This is especially important for children, students, healthcare workers, and individuals with compromised immune systems.
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What is health history and immunization?
Health history is a record of an individual's past and present health conditions, including illnesses, surgeries, medications, and family medical history. Immunization refers to the process of administering vaccines to protect against specific diseases.
Who is required to file health history and immunization?
Individuals seeking to enroll in schools, daycare centers, or healthcare programs may be required to file a health history and immunization record, including students, new employees in certain health sectors, and residents in long-term care facilities.
How to fill out health history and immunization?
To fill out health history and immunization forms, individuals should provide accurate information about their medical history, vaccinations received, dates of those vaccinations, and any allergies or ongoing health issues.
What is the purpose of health history and immunization?
The purpose of health history and immunization is to ensure individuals are adequately protected against preventable diseases, to provide healthcare providers with a comprehensive view of a patient’s health, and to facilitate appropriate medical care.
What information must be reported on health history and immunization?
Health history and immunization reports must include personal identification details, a list of past medical conditions, vaccinations received (including dates), and information about family health history.
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