Get Center For Student Health And Counseling - Pdx

Filling out the Center for Student Health and Counseling Health History Form online is an essential step for students seeking health services. This guide will provide clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter today's date in the specified format (MM/DD/YYYY) at the top of the form.
3. Fill in your PSU ID number and birthdate using the appropriate formats.
4. Indicate your sex at birth by selecting either 'Female' or 'Male'.
5. Check the box that corresponds to your current gender identity: 'Female', 'Male', or other. If you select 'other', please indicate your preferred pronoun.
6. If you have a preferred name that differs from the one in the PSU Information System, provide it in the designated space.
7. Select your year in school from the options provided.
8. Indicate whether you voluntarily enrolled in the PSU Supplemental Health Insurance this term by selecting 'Yes' or 'No'.
9. If you have other insurance outside of PSU, select 'Yes' or 'No'. If 'Yes', please specify the details.
10. Fill in your personal information, including your last name, first name, middle initial, street address, city, state, and zip code.
11. Provide your telephone number in the specified format.
12. Select whether it is okay to leave a confidential message by answering 'Y' or 'N'.
13. If you prefer to be contacted via email, please provide your email address. Acknowledge that email is not confidential by initialing the designated space.
14. Provide details of your emergency contact, including their name, relationship to you, and their telephone number.
15. Select your ethnic identity from the list provided.
16. Indicate any personal and family health histories by checking the relevant boxes.
17. Detail any medication allergies and describe any reactions you have experienced.
18. Provide information on your smoking history.
19. Fill out your immunization history by providing the month and year for each vaccination listed.
20. Document any prior surgeries and hospitalizations, including relevant dates.
21. If applicable, provide details regarding any disabilities and illnesses lasting more than one week.
22. Indicate any current treatments or medications you are receiving, along with pertinent details.
23. For women, provide the date of your last Pap test and indicate if you have had an abnormal Pap result.
24. Select how you heard about the services.
25. Finally, review all the information provided for accuracy before saving changes. Once you are satisfied, you can download, print, or share the form.

Complete your health documentation online to ensure a smooth experience at the Center for Student Health and Counseling.