Get Report Of Health Evaluation Form Revised 6-8-12 - Epcc

Filling out the Report Of Health Evaluation Form Revised 6-8-12 is an important step for students in health occupations programs. This guide provides clear and concise instructions to help you navigate each section of the form with confidence.

Follow the steps to complete your health evaluation form online.

1. Press the ‘Get Form’ button to access the form. This will allow you to download or open the document in an online editor.
2. Begin by entering your last name, first name, and middle name in the designated fields. Make sure to print clearly.
3. Complete your home address details including the number and street, city, state, and zip code.
4. Provide your date of entry into the program and date of birth (DOB) in the specified format.
5. Fill in your home and cell phone numbers, along with your email address.
6. Respond to the medical history questions honestly, indicating any conditions such as heart attack, high cholesterol, or mental health issues.
7. List all family medical history, including conditions like diabetes or cancer, and indicate who you live with.
8. Answer the personal history questions related to infectious diseases, mental health, and any hospitalizations or treatments over the past five years.
9. Provide information about your current medications and any other relevant medical history.
10. Sign and date the form at the bottom to certify that the information provided is correct.
11. If required, have the form reviewed and completed by your examining physician, advanced practice nurse, or physician assistant, ensuring they fill out their section accurately.
12. Once completed, you can save the changes, download, print, or share the form as necessary for submission.

Complete your Report Of Health Evaluation Form online today to ensure you meet the requirements for your health program.