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  • Dhhs Phs-6379 2017

Get Dhhs Phs-6379 2017-2026

OMB No. 09900324; OMB Approval Expires 05/31/2020 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Commissioned Corps SUPPLEMENTAL MEDICAL HISTORY RECORD REQUIRED OF APPLICANTS TO OR.

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How to fill out the DHHS PHS-6379 online

The DHHS PHS-6379 form is essential for those applying to or currently serving as officers in the Public Health Service Commissioned Corps. This guide provides a clear step-by-step approach to completing the form accurately and efficiently.

Follow the steps to complete the DHHS PHS-6379 form online

  1. Click ‘Get Form’ button to obtain the application and display it for filling.
  2. Fill in your last name, first name, and middle initial in the designated fields. Make sure that the names are spelled correctly for official records.
  3. Input your Social Security number in the appropriate section. Providing this number is mandatory for identification and record-keeping purposes.
  4. Carefully review each question about your health history. Respond to each item by checking 'Yes' or 'No'. Ensure you understand each question, as any 'Yes' responses require further explanation.
  5. If you marked 'Yes' for any of the questions, provide detailed explanations in the space provided. Be honest and thorough to avoid disqualification or termination of your application.
  6. For any additional health conditions not covered in the form, describe them in the relevant section. Be comprehensive in your answers to facilitate accurate medical evaluations.
  7. Sign and date the form, certifying that the information you have supplied is true and complete to the best of your knowledge.
  8. After completing the form, save your changes. You may choose to download, print, or share the form as needed.

Complete your application process by filling out the DHHS PHS-6379 online today.

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