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School Based Health Enrollment FormSTUDENT INFORMATION * Student Name: Address City: State/Zip: Phone: Gender: Female or MaleStudent SS #: Pharmacy: Email: Cell: Grade: Race: White, Black, Hispanic
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How to fill out school-based health enrollment form
How to fill out school-based health enrollment form
01
Obtain the school-based health enrollment form from the school's health office.
02
Provide all required personal information such as name, address, date of birth, and contact information.
03
Fill out any medical history or health insurance information as requested.
04
Make sure to sign and date the form where necessary.
05
Return the completed form to the school's health office for processing.
Who needs school-based health enrollment form?
01
Students who wish to enroll in the school-based health program.
02
Parents or guardians of students who require health services at school.
03
School staff members responsible for coordinating student healthcare services.
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What is school-based health enrollment form?
The school-based health enrollment form is a form used to enroll students in school-based health programs.
Who is required to file school-based health enrollment form?
Parents or guardians of the students are required to file the school-based health enrollment form.
How to fill out school-based health enrollment form?
The school-based health enrollment form can be filled out online or by submitting a paper form to the school's health office.
What is the purpose of school-based health enrollment form?
The purpose of the school-based health enrollment form is to ensure that students have access to necessary health services while at school.
What information must be reported on school-based health enrollment form?
The school-based health enrollment form must include the student's name, age, grade, medical history, and emergency contact information.
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