Auburn medical form 2012-2026

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The document provides detailed instructions for completing a medical form required by Auburn University Medical Clinic. It emphasizes the necessity of filling out both pages completely, including the student's social security number and specific immunization records (Tuberculin Skin Test and Measles). A doctor's signature or clinic stamp is mandatory, along with a copy of the insurance card. The document outlines submission methods, billing information, and patient responsibilities regarding medical expenses.

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Click ‘Get Form’ to open the auburn medical form 2012 in the editor.
Begin by entering the student's complete social security number in the designated field. This is crucial for processing.
In the immunization section, ensure you document the required Tuberculin Skin Test (PPD) and Measles (MMR) details, including dates and results.
Have a doctor sign or stamp the form to validate the immunizations. Ensure that a copy of the insurance card is attached as well.
Complete all personal information fields, including emergency contact details and relationship to policyholder.
Finally, make sure both pages are signed where indicated before submitting via fax, email, or mail as per instructions on page one.

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