Get Immunization And Health Screen Send This Form To - Medicine Osu

Filling out the IMMUNIZATION AND HEALTH SCREEN form accurately is essential to ensure your health records are properly documented. This guide will help you navigate each section of the form to complete it effectively.

Follow the steps to accurately complete your immunization and health screen.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin by entering your full name in the designated field at the top of the form. This ensures that your form is correctly associated with your health records.
3. Input your date of birth in the specified section. Use the format MM/DD/YYYY for consistency.
4. Have a physician complete the health screen requirements. You may schedule an appointment with the OSU Student Health Services at the provided phone number.
5. Provide your immunization record. Start with MMR (Measles, Mumps, Rubella) and enter the vaccine dates in the appropriate fields. Ensure the physician initials each entry.
6. List your Varicella (chicken pox) history, including the relevant dates or attach proof if your records are not available.
7. Complete the section on Tetanus/Diphtheria by stating the date of your most recent booster and the type of vaccine administered.
8. Fill in your Hepatitis B vaccine series. Record the dates of your vaccinations and the surface antibody titer results if applicable.
9. Document your 2-step Tuberculin skin test results, including the dates given, read, and results in mm. If a TB blood test was done, attach a copy of the report.
10. Note the date you received the influenza vaccine if applicable, including your physician’s initials.
11. Complete the physician information section with their printed name, address, phone number, signature, and the date of signature.
12. Once all sections are completed, review the form for accuracy. Save your changes and prepare to download, print, or share the completed form as needed.

Complete your immunization and health screen form online to ensure your health documentation is processed efficiently.