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OHS pre-appointment-form-for-traveling-residents docx

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The document is an OHS Pre-Appointment Form for Traveling Residents, designed to collect personal and trip-related information from residents traveling internationally for medical purposes. It includes sections on personal details, trip itinerary, health history, allergies, medications, immunizations, and HIV post-exposure prophylaxis. The form emphasizes the importance of verifying health protocols at international sites and requires submission via email to schedule an appointment with Occupational Health prior to travel.

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Click ‘Get Form’ to open the OHS pre-appointment-form-for-traveling-residents in the editor.
Begin by filling in your personal information. Enter your name, date, department name, email address, work telephone number, and cell number in the designated fields.
Proceed to the Trip Information section. Indicate whether you have traveled internationally before by selecting 'Yes' or 'No'. Provide a detailed itinerary including all countries and dates of travel.
List the names of clinics or hospitals you plan to visit and select your trip's destination type (Urban, Rural, Remote, High altitude, Beach).
In the Health History section, answer questions regarding chronic health problems and current treatments. If applicable, provide explanations in the space provided.
Complete the Allergies and Medications sections by indicating any allergies and listing all medications you are currently taking.
Fill out the Immunizations section with dates of prior immunizations as per your medical records.
Finally, review all entries for accuracy before signing at the bottom of the form. Submit via email as instructed.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (148 Votes)

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What is a pre existing medical condition for travel?

But your insurer is likely to consider any of the following a pre-existing medical condition: any condition youre waiting for an operation on. any condition that youre currently awaiting test results for. any condition, even a minor one, that youve seen a doctor about in the past year.

When should I fill out a travel authorization form?

During the pretravel consultation, clinicians can conduct a risk assessment for each traveler, communicate risk by sharing information about potential health hazards, and manage risk by various means.

What is a travel health appointment?

A consultation with a travel medicine specialist includes discussing travel-related illnesses, risk factors for infectious and noninfectious diseases, required immunizations, health regulations and drug-resistant organisms you may encounter.

What is a pre-travel health consultation?

A typical travel request form includes: Employee information: Name, department, and contact information. Travel details: Destination, purpose of the visit, departure and return dates. Transportation and accommodation: Preferences or arrangements for flights, hotels, car hire, etc.

What is pre-travel?

pretravel ˌprē-ˈtra-vəl. variants or pre-travel. : before travel : occurring or existing prior to travelling. pretravel planning. a pretravel medical consultation.

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