Get Designated Agency To Verify And Complete - Keck Usc

This guide provides a clear, step-by-step approach to filling out the DESIGNATED AGENCY TO VERIFY AND COMPLETE - Keck Usc. Users will find comprehensive instructions tailored for different sections of the document, enabling a smooth online completion process.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the document. This will allow you to obtain the form and open it for editing.
2. Begin by entering your personal information in the designated fields. Fill in your first, middle, and last name, along with your birthdate. Ensure accuracy, as this information is crucial for the clearance certification.
3. Provide your job classification, work facility, and department or division details. If applicable, include the name of your school or employer and your phone number.
4. Complete the identification number field as well as the work area and shift information. This helps in identifying your specific role and schedule.
5. For health clearance completion by a physician or licensed health care professional (PLHCP), ensure that they complete all the related sections and verify the forms are filled fully according to health requirements.
6. If you declined any vaccinations, make sure to attach the required medical documentation as specified. This documentation is necessary for health clearance compliance.
7. Upon completion of the certification by the PLHCP, ensure the signature, date, printed name, license number, facility name/address, and phone number are correctly entered.
8. As the workforce member, you must provide authorization for your health information release by signing the designated area and including the current date.
9. The school or employer must verify all forms are accurately completed. Provide the required signature, date, and contact information for further verification.
10. Review all sections of the form for completeness. Once confirmed, you can save changes, download, print, or share the document as needed.

Complete your documents online to ensure a timely and efficient health clearance process.