Indicate the date to the template with the date tool. Student health and wellness has extended the deadline for health history form submission to august 1.
You may complete the majority of the form by typing information.
Health history form uconn. Uconn's student health history form is due on july 1, 2021. A completed form includes all This form must be submitted by july 1 for fall semester and january 2 for spring semester.
Please compl ete this form. Uconn clinical rotation health review packet (revised 3/25/2021) page ii. Once completed, this form may be dropped off at the uconn health release of information office, 263 farmington avenue, room cg177, farmington, ct;
Division of student affairs applies to: The form may be typed on, or handwritten. Submit health history form submit your health history form , including proof of meningitis immunization.
Apple preview should not be used to complete this pdf; All university students on any uconn campus campus applicability: Students need to download the health history form and have it completed by a health care professional.
Completed health history forms need to be uploaded through the student health portal. Then you may print the filled form to sign. Submit your health history form, including proof of meningitis immunization.
Students who are not compliant with all of the required immunizations by the tenth day of classes will have a hold placed on their student record and will be unable to participate in. Cancer survivor finds peace with new lifestyle. Easily fill out pdf blank, edit, and sign them.
Verification by a physician of a. Incoming students are required to submit proof of required immunizations via this form that is available in the student health portal, myhealth.uconn.edu. Uconn single sign on serves as your login to many university computing and networking services.
This form is to be completed by a parent/guardian. Checklist of clinical health requirements. You will receive your health history form at new student orientation.
Monday through friday 7:30 a.m. Select the sign tool and make a signature. Fill out each fillable field.
Release of information health information management uconn health 263 farmington avenue, mc 2260 Once signed, upload to your enrollment profile on the course enrollment site. Returning students do not need to submit a new form each year.)
You and your doctor/physician complete this form, which documents your immunization history and risk for tuberculosis. This form must be submitted by july 1 for fall semester and january 1 for spring semester. Activate the wizard mode in the top toolbar to have more recommendations.
All enrolled uconn students must submit a student health history form.pdf to the uconn student health services office by august 1 (fall admits) and january 1 (spring admits). 11,970 likes · 197 talking about this · 39,368 were here. Students wishing to reside in university owned housing must submit one of the following prior to moving into the residence halls:
Students who are not compliant with all of the required immunizations by the tenth day of classes will be charged a nonrefundable late fee. All uconn campuses effective date: This form is required for all campuses except:
Then, once completed and signed, upload to the student’s enrollment profile. Submit your health history form by july 1 for fall admits and january 1 for spring admits. Focusing on living in the moment rather than worrying about the future has helped sandra theriault through her cancer survivorship.
Ensure that the information you add to the uconn student health history form is updated and correct. June 4, 2021 for more information, contact student health and wellness services. Uconn health essential workers will be required to:
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