Follow the steps to successfully fill out the form online.

1. Click ‘Get Form’ button to initiate the process and access the online student health form.
2. Begin with Section I, which requires personal details. Fill in your date, full name (last, first, middle), home address, contact numbers, and student college ID. Ensure all fields are completed accurately.
3. For the emergency contact section, provide the name and relationship of an individual who can be contacted in case of an emergency, including their address and telephone numbers.
4. In Section A, indicate any past medical history by checking the 'YES' or 'NO' boxes next to the listed conditions. If you answer 'YES' to any, be prepared to provide details on subsequent pages.
5. Section B requires you to detail diagnoses related to any conditions you marked 'YES' in Section A, including approximate dates and treatments.
6. In Section C, record any surgeries you have had, including dates and types of surgeries.
7. Section D involves listing any medications you are currently taking. Include the name of each medication and any relevant details.
8. In Section E, disclose any physical activity restrictions you have experienced in the last three years and provide reasons for those limitations.
9. Complete Section II by having your physician or nurse practitioner perform a physical examination, reviewing your medical history, and completing the necessary fields regarding health assessments.
10. Finally, ensure that all required signatures are obtained, including yours and that of your healthcare provider. Review the form for any missing information before submission.
11. After completing the form, you can save changes, download, print, or share the document as needed.

Complete your Midlands Technical College Nursing Program Student Health Form online today to ensure your enrollment!