Home
Forms Library
FORM PHS 6379 Supplemental Medical History Record Required of Applicants to the Public Health Servic

FORM PHS 6379 Supplemental Medical History Record Required of Applicants to the Public Health Servic-2026

FORM PHS 6379 Supplemental Medical History Record Required of Applicants to the Public Health Servic Preview on Page 1

See details

4.8 out of 5

41 votes

The document is a Supplemental Medical History Record required for applicants to the Public Health Service Commissioned Corps. It collects confidential medical information to assess the applicant's fitness for duty, particularly regarding substance use and health conditions. The form emphasizes the importance of truthful disclosure, as falsification can lead to disqualification or termination. It also outlines the authority for data collection, its intended use, and implications of nondisclosure.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out FORM PHS 6379 Supplemental Medical History Record Required of Applicants to the Public Health Service with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information at the top of the form, including your last name, first name, middle initial, and social security number. Ensure all details are accurate.
Proceed to the questions regarding your medical history. For each question, select 'YES' or 'NO'. If you answer 'YES' to any question, provide a detailed explanation in the space provided below.
If applicable, list any other conditions that may require future evaluation or treatment in the designated section. Be thorough to ensure proper assessment.
Finally, review all entered information for accuracy. Sign and date the form at the bottom to certify that all information is true and complete.

Start using our platform today for free to easily fill out and manage your FORM PHS 6379!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the history of public health?

The U.S. Public Health Service Act of 1944 broadens USPHS Commissioned Corps scope and paves the way for nurses, scientists, dietitians, physical therapists and sanitarians to join. By 1945, the USPHS Commissioned Corps quadruples its numbers from 625 to nearly 3,000.

What is the origin of the US public health service?

The history of public health is a story of the search for effective means of securing health and preventing disease in the population. Epidemic and endemic infectious disease stimulated thought and innovation in disease prevention on a pragmatic basis, often before the causation was established scientifically.

What is a phs in healthcare?

The Division of Public Health Services (PHS) is responsible for public health services programs and policies. PHS works with Departmental components, particularly those that fund the provision of direct care to vulnerable populations, including primary care, clinical preventive services, and related support services.

What is the history of the public health service?

PHS had its origins in the system of marine hospitals that originated in 1798. In 1871, these were consolidated into the Marine Hospital Service, and shortly afterwards the position of Surgeon General and the PHSCC were established.