Get Student Health Form Pdf - Mount Sinai School Of Medicine - Mssm

Filling out the Student Health Form is essential for maintaining your health records at Mount Sinai School of Medicine. This guide will walk you through each section of the form to ensure you provide all necessary information accurately.

Follow the steps to complete your Student Health Form with ease.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred PDF editor.
2. Start by entering your personal information in the ‘Student Information’ section, including your full name, local address, city, state, zip code, telephone numbers, email, date of birth, age, and birthplace. Indicate your marital status by selecting the appropriate option.
3. Proceed to the ‘Emergency Contact Information’ section. Input the name, relationship, address, city, state, zip code, and contact numbers for your emergency contact.
4. In the ‘Primary Care Information’ section, provide the name of your primary care provider, their address, and telephone number. You may also list any specialists you see along with their contact information.
5. Move on to the ‘Medical History’ section. Carefully check all relevant medical conditions that apply to you from the provided list.
6. Continue with the ‘Family History’ section, indicating any family members with significant medical conditions by checking the applicable boxes.
7. Next, complete the ‘Personal History’ section by checking all personal medical issues you have experienced, as listed.
8. In the ‘Additional Information’ section, answer the questions regarding any interruptions in education or work due to medical reasons, list medications including dosages, detail any hospitalizations or surgeries, and specify any allergies.
9. Once you have filled out all sections of the form, review your entries for accuracy and completeness.
10. Finally, save your changes, and choose to download, print, or share the completed form as needed.

Complete your Student Health Form online today to ensure your health records are up to date.