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ID#___ BERGEN COMMUNITY COLLEGE HEALTH SERVICES RECORD/ROOM HS100 healthservices@bergen.edu Office:(201)4479257 Fax: (201) 4470327 Email:___ ___/___/___ Last Name (Please Print) First Middle initial
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Gather all necessary information such as personal details, emergency contacts, medical history, and any current medications.
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Carefully read each section of the form and provide accurate and detailed information.
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Who needs regular student medical form?

01
Regular student medical form is typically required for all students attending a school or educational institution.
02
It is also necessary for students participating in sports or other extracurricular activities.
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The regular student medical form is a document that collects health information about students to ensure their safety and well-being while they are enrolled in an educational institution.
Typically, all students enrolled in a school or university are required to file the regular student medical form, particularly new students or those participating in certain programs or activities.
To fill out the regular student medical form, students must complete sections that include personal information, medical history, immunization records, and emergency contact details, ensuring that all information is accurate and up-to-date.
The purpose of the regular student medical form is to maintain a record of students' health needs, identify any potential medical concerns, and provide necessary information to emergency responders.
The information reported on the regular student medical form includes the student's name, date of birth, health insurance details, medical history, current medications, allergies, and immunization status.
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