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Mental health / Attention / Attention deficit hyperactivity disorder / Educational psychology / Neringa municipality / Allergy / Medicine / Health / Psychiatry


Do not staple Vermont does not mandate a physician’s signed health form; your answers are required to assist us in identifying appropriate
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Document Date: 2014-01-30 17:53:36

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Company

Brattleboro Primary Care / /

Facility

Camp Neringa / CAMP NERINGA Camper / Camp Neringa’s / /

IndustryTerm

transportation / public relations / insurance carrier/plan / food / /

MedicalCondition

ADHD / Food allergies / sleepwalking / injury / headaches / convulsions / learning disabilities / seizures / hay fever / eating disorder / diarrhea / Pertussis / Chicken pox / illness / constipation / chronic / infections / infectious disease / Tetanus / disorders / /

MedicalTreatment

surgery / First Aid / /

Position

physician / Physician ___________________________________Physician / General / /

Product

Tylenol / Acetaminophen / Benadryl / Motrin / Ibuprofen / hydrocortisone / Advil / /

ProvinceOrState

Vermont / /

SocialTag