| Document Date: 2014-07-08 12:16:09
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City Fremont / / / Facility Midland University / / / IndustryTerm local healthcare / / MedicalCondition Allergies / meningococcal infections / Headaches / Mumps / disease / headache / Kidney Disease / relatively rare disease / pertussis / Measles / HPV / meningococcal meningitis / Chicken Pox / Mental Illness__________________________________ FAMILY HISTORY Asthma____________ Cancer / HIGHLY RECOMMENDED Tetanus / severe bacterial infection / diphtheria / tetanus / Heart Disease / serious illness/injury / Diabetes / Hepatitis B / Heart Disease___________ Tuberculosis________ High Blood Pressure______ Bleeding Disorders / fever / bacterial meningitis / vomiting / meningococcal disease / Rubella / Gastrointestinal Disorder_________________________ Hepatitis / Mental Illness / Epilepsy / infection / illness / MENINGITIS / rash / Varicella / Alcoholism / Asthma / / MedicalTreatment immunization / immunizations / antibiotics / resuscitation / vaccinations / VACCINATION / surgery / / Organization the American College / Midland University / Centers for Disease Control and Prevention / / / Position physician / / Product Penicillin / rifampin / / ProvinceOrState Nebraska / / Technology cellular telephone / / URL www.acha.org/projects_programs/meningitis/index.cfm / www.cdc.gov/meningitis/index.html / /
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REQUIRED HEALTH RECORD (All students must return completed form prior to the start of classes.) Student Health Midland University Email: [removed]