Get Form A - Lebanon Valley College - Lvc

Filling out FORM A for Lebanon Valley College is an essential step for students requiring special housing accommodations due to asthma and allergies. This guide will provide you with clear, step-by-step instructions to complete the form effectively.

Follow the steps to complete FORM A successfully.

1. Click ‘Get Form’ button to obtain the form and open it in your document management tool.
2. Begin by entering your name and the date at the top of the form in the designated fields.
3. In the 'Medical Provider Information' section, ensure the health professional completes all requested details. They should provide their name and the necessary medical information regarding the student's asthma and allergies.
4. Under the 'Consent for Release of Information,' the student must sign and date the form. This allows the medical provider to share information with the Student Affairs staff.
5. For asthma-related information, select the current diagnosis from the options provided and list any current medications, including their names and dosages.
6. Check any relevant statements regarding the patient's past asthma-related care, including dates of severe exacerbations or hospital admissions.
7. In the allergies section, indicate the current diagnosis and list any allergy medications, including frequency.
8. Review and check any statements that apply to allergy history, such as prior immunotherapy.
9. Complete any additional comments from the medical provider as necessary, using the reverse side if more space is needed.
10. Once all fields are filled out, save changes to the document. You can then download, print, or share the completed form.

Ensure your housing accommodations are secured by completing FORM A online today.