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HS-HealthCenterForm-11x17 16.indd

HS-HealthCenterForm-11x17 16.indd 2025

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4.8 out of 5

250 votes

The document is a comprehensive health services report for students at Lebanon Valley College, requiring completion of medical history, immunization records, and consent for treatment. It includes sections for personal and family medical history, a physician's evaluation report, and insurance information. Students must provide necessary health details to facilitate their care while enrolled, with specific requirements for incoming freshmen and transfer students.

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Click ‘Get Form’ to open the HS-HealthCenterForm-11x17 16.indd in the editor.
Begin by filling out your personal information on the first page, including your last name, first name, middle initial, date of birth, and contact details. Ensure accuracy as this information is crucial for health services.
Proceed to the family history section. Indicate any medical conditions present in your family by checking the appropriate boxes and providing details where necessary.
In the personal history section, answer all questions honestly. If you have had any medical conditions or treatments, check 'Yes' and provide additional details if needed.
Complete the physician’s report section by ensuring that your healthcare provider fills it out accurately. This includes vital signs and any recommendations for care.
Review the immunization policy section carefully. Fill in all required vaccine dates and ensure you attach any necessary documentation.
Finally, complete the insurance information and consent for treatment sections if applicable. Make sure to sign where indicated.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (250 Votes)
2019	4.4 Satisfied (287 Votes)
2013	4.3 Satisfied (36 Votes)

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