Get Graduate Student Health Record Form - Lipscomb University - Lipscomb

This guide aims to assist users in properly completing the GraDuatE StuDENt HEaltH RECorD Form for Lipscomb University. By following these steps, you can ensure that your health information is accurately documented and submitted for your enrollment process.

Follow the steps to successfully complete the health record form.

1. Press the ‘Get Form’ button to access the health record form and open it for editing.
2. Fill in your full name, social security number, home address, and contact information, including home phone, cell phone, and email address. Make sure to provide your date of birth and indicate your citizenship status.
3. Identify and enter the name of your parent, guardian, or partner, along with their contact details and address.
4. Provide the name and number of an emergency contact, along with your relationship to that person.
5. Specify the semester you are entering, using options for Fall, Spring, or Summer, and indicate whether you were a former Lipscomb University student.
6. Complete the section regarding your program of study and mark any relevant medical history and allergies. Be sure to include explanations for any conditions marked by attaching an extra sheet if necessary.
7. List any current medications you take, including over-the-counter drugs and supplements.
8. Attach an official immunization record or ensure your healthcare provider signs the form to validate your immunization dates for MMR and Varicella.
9. Complete the TB Assessment section by answering the questions regarding tuberculosis diagnosis and exposure risk factors. If you answer 'Yes' to any relevant questions, provide additional documentation as required.
10. If applicable, fill out the TB skin test results section after receiving the test within the last 12 months.
11. Review all entered information for accuracy and completeness, then save the changes, download the form, and prepare for printing or sharing as needed.

To ensure a smooth enrollment process, be proactive in completing your health record form online.